Facharzt FMH Neurochirurgie Practice Questions - Facharzt FMH Für Neurochirurgie Spécialiste FMH En Neurochirurgie Exam

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A 54-year-old woman presents to the emergency department with a sudden-onset thunderclap headache, transient loss of consciousness, and meningism. Non-contrast cranial CT reveals extensive subarachnoid hemorrhage in the basal cisterns with acute ventriculomegaly (Hunt & Hess Grade 3, modified Fisher Grade 3). CT angiography demonstrates a 6 mm saccular anterior communicating artery (ACoA) aneurysm. Her GCS score declines from 13 to 10 in the resuscitation bay with increasing somnolence. What is the most appropriate immediate sequence of interventions?

Immediate placement of an external ventricular drain (EVD) to manage acute hydrocephalus, followed by urgent aneurysm securing (coiling or clipping) within 24 to 72 hours Administration of high-dose intravenous methylprednisolone and deferred aneurysm securing until brain swelling subsides at day 10 Immediate high-volume lumbar puncture to clear bloody CSF, followed by elective outpatient aneurysm embolization Induction of profound hypervolemic-hypertensive therapy (triple-H) prior to invasive vascular imaging or CSF diversion

Correct Answer:

Immediate placement of an external ventricular drain (EVD) to manage acute hydrocephalus, followed by urgent aneurysm securing (coiling or clipping) within 24 to 72 hours

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