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

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A 49-year-old man who underwent successful endovascular coiling of a ruptured right middle cerebral artery (MCA) aneurysm develops new left-sided hemiparesis and pronator drift on post-bleed day 7. His blood pressure is 118/72 mmHg and heart rate is 68 bpm. Daily transcranial Doppler (TCD) shows right MCA mean flow velocities increased from 110 cm/s to 215 cm/s (Lindegaard ratio 4.8). CT angiography confirms focal severe vasospasm of the right M1 segment without intracranial rebleeding or infarction. According to current European guidelines for Delayed Cerebral Ischemia (DCI), what is the first-line therapeutic management?

Aggressive fluid restriction (1 L/day) and therapeutic hypothermia (target 33°C) Induced hypertension using continuous noradrenaline/norepinephrine to maintain elevated MAP while maintaining strict euvolemia, alongside continued oral nimodipine Immediate surgical exploratory craniotomy for mechanical vessel stripping and papaverine irrigation Discontinuation of oral nimodipine due to suspected drug-induced cerebral steal phenomenon

Correct Answer:

Induced hypertension using continuous noradrenaline/norepinephrine to maintain elevated MAP while maintaining strict euvolemia, alongside continued oral nimodipine

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