Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage is a complex disorder with a high morbidity and mortality. Primary injury occurs at the time of aneurysmal rupture, and subsequently the brain is threatened by a number of secondary complications. Hydrocephalus and aneurysm re-bleeding lead to early decline, while cerebral vasospasm and delayed cerebral ischemic lead to a later deterioration. Cardiovascular stabilization and aneurysm treatment with either neurosurgical clipping or endovascular coiling are the focus of management soon after rupture. Development of hydrocephalus may need placement of an external ventricular drain for CSF diversion. Following initial stabilization, patients are admitted to a dedicated neurosciences intensive care unit and cared for by a team of trained and experienced providers well versed with this disorder. Careful neurological examination supplemented by radiologic tools such as transcranial Doppler and CT perfusion scan is used to monitor for cerebral vasospasm and delayed cerebral ischemia. This chapter focuses on a practical approach to the clinical presentation, diagnosis, and management of aneurysmal subarachnoid hemorrhage and discusses the specific management of complications commonly seen during the hospitalization.