A 52-year-old woman with aneurysmal subarachnoid haemorrhage (day 4) develops worsening confusion and left arm weakness; transcranial Doppler shows raised velocities in the right MCA consistent with delayed cerebral ischaemia. The evidence-based oral agent to reduce this complication is:

• A Flunarizine 10 mg daily for 14 days
• B Nimodipine 60 mg every 4 hours for 21 days ✓
• C Nifedipine 20 mg twice daily for 21 days
• D Verapamil 120 mg three times daily for 14 days

Explanation

Oral nimodipine, a dihydropyridine calcium channel blocker given as 60 mg every 4 hours for 21 days after aneurysmal SAH, improves outcome and reduces delayed cerebral ischaemia; it is standard of care even though it does not reliably reverse angiographic spasm. Other calcium channel blockers such as nifedipine and verapamil lack trial-proven benefit and are used only intra-arterially in rescue therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.