Management of sub-arachnoid haemorrhage

Spontaneous subarachnoid haemorrhage (SAH) is a neurovascular emergency with sudden onset, which requires rapid recognition and early treatment to minimize the occurrence of serious complications. The most common cause is a cerebral aneurysm, which develops at areas of turbulent flow, especially within the circle of Willis. Initial aims are to provide appropriate resuscitation to the patient and to maintain cerebral oxygenation and perfusion. Anaesthesia involves prompt airway control and precise management of physiological parameters to reduce further neurological injury, such as from re-bleeding or delayed cerebral ischaemia. Once stabilized SAH patients should be admitted to a neurointensive care unit and managed by a skilled multidisciplinary team. Definitive treatment then involves either endovascular coiling or surgical clipping, preferably in hospitals managing high volumes of SAH cases per year. Care should be also taken throughout to avoid non-neurological complications such as infections or venous thromboembolism.