Management of subarachnoid haemorrhage

Subarachnoid haemorrhage is an acute neurosurgical emergency affecting patients of all ages and with high mortality. It is usually caused by rupture of an aneurysm of an intracranial artery at a point of turbulent blood flow within the circle of Willis. Diagnosis should be made rapidly initially with non-contrast CT of the head. Minimizing secondary neurological injury is the focus of care. Initial stabilization focussing on providing adequate cerebral oxygenation and perfusion should be carried out expediently and this may require intubation and ventilation. Transfer to a specialist neurosciences centre for ongoing management is the next priority. Culprit aneurysms should be secured promptly by endovascular coiling or surgical clipping. Recognition and management of complications is best undertaken in a centre managing high volumes of these patients. Vasospasm is a common and feared complication of subarachnoid haemorrhage. All patients should be given nimodipine for prophylaxis and management of this complication.