A 50-year-old woman undergoes endovascular coiling of a ruptured anterior communicating artery aneurysm on day 0. On day 5 post-SAH, she develops worsening confusion and new right hemiparesis. Transcranial Doppler shows elevated mean flow velocities in the middle cerebral artery. Which medication is the standard prophylactic agent for this complication?

• A Intravenous heparin infusion
• B Oral aspirin 325 mg daily
• C Intravenous phenytoin loading
• D Oral nimodipine 60 mg every 4 hours ✓

Explanation

The patient has symptomatic cerebral vasospasm, the leading cause of delayed morbidity after SAH, peaking days 4-14. Nimodipine, an oral calcium channel blocker, is the only agent proven to improve neurological outcomes after SAH and is given to all SAH patients for 21 days. It acts via vasospasm-independent neuroprotective mechanisms. Anticoagulation is contraindicated post-coiling. Phenytoin does not prevent vasospasm (Greenberg, Handbook of Neurosurgery, 9th ed.).

Reference: Greenberg's Handbook of Neurosurgery, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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