Aneurysmal Subarachnoid Haemorrhage

Acute aneurysmal subarachnoid haemorrhage (aSAH) is associated with significant morbidity and mortality. The worldwide incidence is approximately 9 per 100,000 per year; however, there are regional differences. Accurate, timely diagnosis and treatment is imperative to avoid aneurysmal re-rupture, which has a mortality in the region of 80%. For patients that survive the initial aSAH, the re-rupture rate is approximately 5% in the first 24 hours and thereafter, approximately 1% per day. Patient outcome may be further compromised by complications such as seizures, cerebral vasospasm, cerebral infarction, electrolytes disturbances and hydrocephalus. Definitive treatment of patients admitted with acute aSAH is based on early exclusion of the aneurysm from the circulation in order to prevent rebleeding and for many years, the treatment of choice was an open craniotomy and surgical clipping of the aneurysm. However, over recent years the development of interventional neuroradiological techniques has provided alternative less invasive management options that raise a number of ethical issues that must be considered when faced with a patients with an acute aSAH.