What is the treatment approach for vasospasm after a hemorrhagic stroke?

What is the treatment approach for vasospasm after a hemorrhagic stroke?

• A. High-dose steroids
• B. Nimodipine is often used to prevent vasospasm after a hemorrhagic stroke
• C. Immediate plasmapheresis
• D. Anticoagulation with heparin

Answer: (B)

Vasospasm after hemorrhagic stroke is prevented and treated to reduce delayed cerebral ischemia, and the drug most consistently shown to help is nimodipine. This medication is a brain-selective calcium channel blocker that penetrates the central nervous system and causes dilation of cerebral vessels, which lowers the risk and severity of vasospasm after subarachnoid hemorrhage and improves neurologic outcomes. Nimodipine is given by mouth or through a feeding tube at 60 mg every 4 hours for about 21 days. It’s important to start it as soon as feasible after the bleed and to monitor blood pressure closely because nimodipine can cause hypotension; dose adjustments may be needed if blood pressure drops significantly. Other options don’t fit the goal of preventing vasospasm in this setting: high-dose steroids have not been shown to prevent vasospasm or improve outcomes in hemorrhagic stroke, plasmapheresis is not a standard treatment for vasospasm, and anticoagulation with heparin would risk expanding the bleed in an active hemorrhagic event.

Vasospasm after hemorrhagic stroke is prevented and treated to reduce delayed cerebral ischemia, and the drug most consistently shown to help is nimodipine. This medication is a brain-selective calcium channel blocker that penetrates the central nervous system and causes dilation of cerebral vessels, which lowers the risk and severity of vasospasm after subarachnoid hemorrhage and improves neurologic outcomes.

Nimodipine is given by mouth or through a feeding tube at 60 mg every 4 hours for about 21 days. It’s important to start it as soon as feasible after the bleed and to monitor blood pressure closely because nimodipine can cause hypotension; dose adjustments may be needed if blood pressure drops significantly.

Other options don’t fit the goal of preventing vasospasm in this setting: high-dose steroids have not been shown to prevent vasospasm or improve outcomes in hemorrhagic stroke, plasmapheresis is not a standard treatment for vasospasm, and anticoagulation with heparin would risk expanding the bleed in an active hemorrhagic event.