Decision making in patients with subarachnoid hemorrhage

Diagnostic and therapeutic management options in cases of subarachnoid hemorrhage secondary to aneurysm rupture are discussed. Particular emphasis is given to the diagnosis, medical treatment and timing of surgery. The problems raised by the presence of an intracerebral hematoma, acute hydrocephalus and multiple aneurysms are reviewed. The author also discusses the management of incidental aneurysms, partially treated lesions, familial and genetic aneurysms, lesions which ruptured during pregnancy or associated with arterio-venous malformations, and the question of a negative angiogram in cases of subarachnoid hemorrhage.