Which of the following medications would be most appropriate to reduce intracranial pressure immediately when a patient with stroke presents to the emergency department?

In the context of managing acute intracranial pressure (ICP), hypertonic saline, such as 3% sodium chloride (NaCl), is considered one of the most effective first-line treatments. The mechanism by which hypertonic saline works involves the creation of an osmotic gradient that draws water out of swollen brain tissue, thereby reducing cerebral edema and lowering ICP.

When a patient presents with a stroke and indications of elevated intracranial pressure, immediate intervention is crucial to prevent further neurological damage. The intravenous infusion of 3% NaCl can rapidly correct the fluid balance in the patient’s central nervous system and effectively lower ICP.

Other choices, while important in various contexts, do not provide the immediate effect needed to address a critical elevation in ICP. For instance, decompressive craniotomy, although a highly effective surgical intervention for refractory ICP, is not an immediate pharmaceutical approach. Dexamethasone could be beneficial in cases of brain tumors or other inflammatory processes causing edema but is not first-line treatment for an acute stroke. Acetaminophen is an analgesic that does not address the underlying cause of high ICP and would not have an impact on reducing it in a stroke patient.

Thus, the administration of 3%