Abstract
Subarachnoid haemorrhage (SAH) accounts for only 5% of all strokes, but is responsible for 25% of all fatalities related to stroke. The most important vascular risk factors for SAH are hypertension, smoking and high alcohol intake. One-quarter of patients with acute SAH are not diagnosed at their first medical encounter. To identify the aneurysm causing SAH and allow urgent treatment, angiography must be performed as soon as possible. The most important neurological complications of SAH are re-bleeding, intracerebral haematoma and intraventricular haemorrhage, vasospasm, delayed cerebral ischaemia, hydrocephalus and seizures. Patients with SAH should be referred urgently to a tertiary care centre with expertise in cerebral aneurysm treatment, including endovascular, neurosurgical and neurointensive care. Currently, we can recommend that in a patient with acute aneurysmal SAH in whom both coiling and clipping are feasible, coiling is the preferred choice, if it can be performed within 72 hours after SAH. Adequate fluid replacement and calcium channel blockers are used to prevent vasospasm. Future health gains in SAH will depend on co-ordinated efforts between basic research and clinical research.
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