Modern management of aneurysmal subarachnoid hemorrhage.

This article reviews the modern approach and advances in the management of aneurysmal subarachnoid hemorrhage. Early diagnosis along with aggressive medical and surgical clipping appears to reduce morbidity and mortality. Computed tomography scan is greater than 95% sensitive for diagnosis. Aneurysm clipping within 48 hours has been performed successfully in 44 patients at the Indiana University Medical Center in Indianapolis. Early aneurysm clipping allows a more aggressive approach to managing the 20% to 30% incidence of delayed ischemic vasospasm. These aggressive treatments include transcranial Doppler analysis, volume expansion, hypertensive therapy, hemodilution and calcium channel blockers. Additional treatment strategies are being investigated to prevent vasospasm.