The early management of patients with SAH involves an integrated, multidisciplinary team of neurologists, neurosurgeons, neurointerventional physicians, and intensive care unit physicians. Patients should be hospitalized in a stroke unit or intensive care unit, with frequent monitoring of vital signs and neurologic status. Those individuals having a decline in consciousness or a compromised airway are intubated. Measures to prevent or treat cardiac arrhythmias, hypertension, electrolyte or metabolic disturbances, or other medical complications are instituted. Increased intracranial pressure is managed with placement of a ventricular drain or medications such as hypertonic saline or mannitol. Symptoms such as pain, nausea, vomiting, or agitation should be medically treated.

Either surgical clipping of the aneurysm or endovascular occlusion (placement of coils) is performed as soon as the patient’s condition permits. The goal is to prevent recurrent hemorrhage. Nimodipine is approved for prevention of cerebral ischemia secondary to vasospasm. Patients who develop ischemic symptoms are treated with hypervolemic hemodilution and induced hypertension, intra-arterial administration of vasodilators, or angioplasty, depending on the severity of the vasospasm.

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