Management of subarachnoid haemorrhage

Subarachnoid haemorrhage resulting from a ruptured cerebral aneurysm requires advanced medical and surgical care to maximize patient outcomes. In the acute period, care is focused on rapid diagnosis and repairing the aneurysm with either clipping or coiling to prevent further haemorrhage. In the days to weeks that follow, the focus shifts to optimizing cerebral perfusion in order to prevent delayed ischaemia. Patients are best served by a multimodality team that can weigh the risks and benefits of treatment based on aneurysm characteristics, clinical scenario, best available evidence, and provider skill level. While controversy exists over various treatment modalities and management protocols, widespread advances in surgical and endovascular techniques and vasospasm care continue to decrease morbidity and mortality associated with this challenging disease.