In Hospital Course

The diagnosis of subarachnoid hemorrhage is typically made with CT; if CT is negative, usually a lumber puncture needs to be performed unless the CT is made within 6 h after onset of the hemorrhage and read by a staff radiologist. Once the diagnosis of subarachnoid hemorrhage has been made, the ruptured aneurysm is usually searched for by means of CT angiography. The most feared complication is rebleeding from the aneurysm, which has its highest peak in the initial hours after the hemorrhage. Currently, no therapy is available that can reduce this risk in the initial hours. If the patient has survived the initial hours and is admitted in a referral center, the aneurysm will usually be occluded early after admission by either coiling or clipping to prevent rebleeding during the clinical course; if both treatment options are technically feasible, coiling is the preferred option. Other neurological complications that can occur in the initial 1–2 weeks after the hemorrhage are delayed cerebral ischemia, for which treatment with oral nimodipine is the only effective preventive treatment, and hydrocephalus.