TEN Neurologia Practice Questions - TEN - Título De Especialista Em Neurologia (Academia Brasileira De Neurologia AMB) Exam

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A 48-year-old woman presents to the emergency department after experiencing the sudden onset of the 'worst headache of her life' accompanied by neck stiffness and photophobia. Non-contrast cranial CT reveals diffuse hyperdensity in the basal cisterns and Sylvian fissures consistent with acute aneurysmal subarachnoid hemorrhage (aSAH). Digital subtraction angiography identifies a 7 mm saccular aneurysm of the anterior communicating artery. To prevent delayed cerebral ischemia (DCI) and secondary neurological deterioration, which pharmacologic intervention is recommended as Class I evidence?

Oral Nimodipine 60 mg every 4 hours for 21 consecutive days. Intravenous magnesium sulfate infusion titrated to achieve serum levels of 2.5–3.0 mmol/L. Prophylactic hypervolemic-hypertensive-hemodilution ('Triple-H') therapy initiated immediately upon admission. High-dose intravenous methylprednisolone 1 g daily for 5 days to reduce sterile meningeal inflammation.

Correct Answer:

Oral Nimodipine 60 mg every 4 hours for 21 consecutive days.

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