Medical management of subarachnoid hemorrhage

The medical management of the subarachnoid hemorrhage patient has changed considerably over the past two decades. The widespread acceptance of early aneurysm obliteration allows the aggressive prophylaxis and treatment of many of the serious complications of this condition. Recognition of cerebral vasospasm and the prevention of the delayed ischemic deficits it can produce are the cornerstones of critical care for these patients. Analysis of their fluid and electrolyte disturbances is complex, but important for the optimization of intravascular volume and consequent cerebral blood flow. Recognition of the numerous infectious and other medical complications that can befall these patients aids in the attempt to restore them to as normal a functional capacity as is possible.