Today's approach to managing aneurysmal subarachnoid hemorrhage: How interventional neuroradiology is changing treatment strategies

When a patient presents with nontraumatic headache and the index of suspicion for SAH is high, a CT scan should be ordered to detect blood accumulation in the subarachnoid space. Lumbar puncture should be reserved for patients with normal CT scans when there is a persistent concern about hemorrhage. SAH usually originates from a ruptured intracranial aneurysm; this cerebrovascular abnormality is best diagnosed and assessed with transfemoral cerebral angiography. If the aneurysm has a well-defined neck, surgical clipping is the usual treatment. However, in selected cases, endovascular therapy may be considered. Embolization coils may be placed within the aneurysmal dome to induce thrombosis, or detachable balloons may be used to occlude the aneurysm and sometimes the parent artery as well.