← Guidelines

Aneurysmal subarachnoid haemorrhage

Drawing on American Heart Association / American Stroke Association and Neurocritical Care Society guidance.

• Secure the aneurysm early. Treatment as soon as feasible reduces rebleeding, which carries very high mortality and peaks in the first 24 hours.
• Nimodipine for all patients. 60 mg orally every four hours for 21 days. It improves neurological outcome; notably, this appears not to be explained by any effect on angiographic vasospasm.
• Maintain euvolaemia. Prophylactic hypervolaemia and the older “triple-H” approach are no longer recommended; induced hypertension is reserved for established delayed cerebral ischaemia.
• Watch for delayed cerebral ischaemia between days four and fourteen, with serial neurological examination as the primary monitor.
• Blood pressure before securing: control extreme hypertension while preserving perfusion. The precise target is not well established by trial evidence.