A 52-year-old woman with aneurysmal subarachnoid hemorrhage is stable on day 5 when she develops new left hemiparesis and confusion. Transcranial Doppler shows elevated velocities in the right middle cerebral artery. What is the correct statement regarding her management?

• A Oral nimodipine reverses established cerebral vasospasm
• B Triple-H therapy is contraindicated after aneurysm coiling
• C Vasospasm peaks within the first 48 hours after hemorrhage
• D Induced hypertension and hypervolemia plus endovascular therapy are used for symptomatic vasospasm ✓

Explanation

Symptomatic vasospasm typically appears between days 4 and 14, peaking around days 6 to 8, and is managed with induced hypertension and volume expansion, with intra-arterial vasodilators or angioplasty for refractory cases. Oral nimodipine improves outcome but does not reverse radiographic vasospasm, so option A is false, and the peak is not within 48 hours.

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

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Written and medically reviewed by the StethoPrep medical team.