American Board of Internal Medicine (ABIM) Certification Practice Exam

What medication helps prevent vasospasm after an aneurysmal subarachnoid hemorrhage?

1. Oral nimodipine

2. Oral anticoagulants

3. Intravenous calcium

4. Intramuscular steroids

The correct answer is: Oral nimodipine

Nimodipine is a calcium channel blocker that is specifically utilized to prevent vasospasm following an aneurysmal subarachnoid hemorrhage (SAH). This type of hemorrhage often leads to complications such as delayed cerebral ischemia due to vasospasm of the cerebral arteries. Nimodipine works by selectively dilating the cerebral blood vessels, thereby reducing the risk of vasospasm and improving overall cerebral blood flow. The use of oral nimodipine has been shown in clinical studies to decrease the incidence of poor neurological outcomes attributed to vasospasm in patients who have experienced SAH. Therefore, its administration is a standard recommendation in the management of these patients in the neurocritical setting. Other medications mentioned do not play a role in preventing vasospasm specifically after an aneurysmal SAH. Oral anticoagulants are typically used in different clinical scenarios, such as for preventing thromboembolic events, but they are not indicated for vasospasm prevention. Intravenous calcium is not utilized in this context, as the focus is on preventing vasospasm rather than modifying calcium levels systemically. Similarly, intramuscular steroids do not have a therapeutic role in addressing the complications following SAH, making nimodip