Five days after coiling of a ruptured anterior communicating artery aneurysm, a patient develops new left hemiparesis and confusion. Transcranial Doppler shows right middle cerebral artery mean flow velocity of 210 cm/s. Which drug, started after the bleed, has been shown to improve outcome in this situation?

• A Aspirin 300 mg daily for 14 days
• B Nimodipine 60 mg orally every 4 hours for 21 days ✓
• C Dexamethasone 16 mg daily for 10 days
• D Heparin infusion targeted to an APTT ratio of 1.5

Explanation

Delayed cerebral ischaemia from arterial vasospasm peaks between days 4 and 14 after subarachnoid haemorrhage. Oral nimodipine 60 mg four-hourly for 21 days is the only pharmacological agent shown to improve functional outcome after SAH; its benefit is more on neuroprotection than on angiographic calibre. Mean MCA velocities above 200 cm/s on transcranial Doppler suggest severe spasm. Steroids and anticoagulation have no role, and antiplatelet therapy does not prevent vasospasm.

Reference: Kaye's Essential Neurosurgery, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.