A 52-year-old woman undergoes surgical clipping of a ruptured anterior communicating artery aneurysm. On post-bleed day 7, she develops progressive confusion and new right hemiparesis. Transcranial Doppler shows increased flow velocities in the middle cerebral artery. What is the standard prophylactic treatment that should have been administered from the time of aneurysm securing?
- A Oral nimodipine for 21 days ✓
- B Intravenous heparin infusion
- C Hypervolemic hypertensive therapy (triple-H therapy)
- D Intra-artery verapamil infusion
Correct answer: A. Oral nimodipine for 21 days
Explanation
Oral nimodipine 60 mg every 4 hours for 21 days is the standard prophylactic treatment after aneurysmal SAH, shown to improve neurological outcomes by reducing cerebral vasospasm-related ischemia. It should be started within 96 hours of hemorrhage and continued for 21 days. Triple-H therapy is used for symptomatic vasospasm, not prophylaxis. Intra-arterial verapamil is an interventional treatment for established severe vasospasm.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.