Four days after admission for aneurysmal subarachnoid hemorrhage, a patient becomes drowsy with new left hemiparesis. Transcranial Doppler shows markedly elevated velocities in the right middle cerebral artery. Which drug reduces the risk of delayed cerebral ischemia in this situation?
- A Nimodipine ✓
- B Atorvastatin
- C Heparin infusion
- D Mannitol
Correct answer: A. Nimodipine
Explanation
Oral nimodipine, a dihydropyridine calcium channel blocker, started within 96 hours of aneurysmal subarachnoid hemorrhage improves outcomes by reducing delayed cerebral ischemia, although it does not reliably reverse angiographic vasospasm. Mannitol is used for raised intracranial pressure, not vasospasm. Prophylactic heparin is not standard and risks rebleeding. Statins have been studied but do not have established benefit comparable to nimodipine.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.