A 55-year-old woman is on day 7 after coiling of a ruptured anterior communicating artery aneurysm. She becomes drowsy and develops new left-sided weakness. CT shows neither infarct nor hydrocephalus, and transcranial Doppler shows mean middle cerebral artery velocities of 180 cm/s. Alongside maintenance of euvolaemia and induced hypertension, which specific drug reduces delayed cerebral ischaemia in this setting?
- A Oral aspirin 300 mg daily
- B Intravenous magnesium sulphate infusion
- C Oral nimodipine 60 mg four times daily ✓
- D Intravenous heparin infusion
Correct answer: C. Oral nimodipine 60 mg four times daily
Explanation
Nimodipine, a calcium channel blocker given orally as 60 mg every 4 hours for 21 days, is the only pharmacological agent proven to improve outcome after aneurysmal subarachnoid haemorrhage by reducing delayed cerebral ischaemia. Clinical vasospasm typically peaks between days 4 and 14, matching this presentation. Magnesium trials showed no outcome benefit. Aspirin and heparin do not reverse large artery spasm and add haemorrhagic risk in the post-bleed period.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.