Abstract
Summary The current management of patients with aneurysmal subarachnoid haemorrhage (SAH) begins with early diagnosis using cranial computed tomography and cerebral angiography. In general. rebleeding is best prevented by early surgery and aneurysm clipping. with antifibrinolytics reserved for patients at low risk of vasospasm in whom early surgery is impossible. Anticonvulsants to prevent or treat seizures. and the maintenance of normal serum sodium levels and intracranial pressure are advisable in the immediate period after haemorrhage. Patients should be maintained with normo- or hypervolaemia. Nimodipine is indicated to prevent vasospasm. one of the causes of delayed neurological deficits associated with SAH. Deterioration due to vasospasm. and possibly patients at high risk for vasospasm. should be treated with induced hypervolaemia (to maximise cardiac output) and induced hypertension. and. possibly. haemodilution. Transluminal angioplasty and intra-arterial papaverine are other options in the setting of delayed ischaemia that is unresponsive to the above measures. Intracisternal fibrinolysis with alteplase should be considered in patients with thick SAHs.
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