Purpose of review: Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with high mortality and poor outcome among survivors. Early surgical or endovascular securing of the aneurysm is the norm, and management of these patients is precarious due to their unstable intracranial physiology and the severe systemic medical complications common in SAH.
Recent findings: New research into biomarkers and clinical factors with their association to outcome in SAH can help us to identify patients at risk. New evidence questions the benefit of broad application of the current SAH treatment mainstays, and re-examines agents previously failing clinical trials.
Summary: Growing knowledge of the physiologic derangements associated with poor outcomes in SAH can improve our understanding of the widespread physiologic changes occurring with SAH and with further research, may provide clinicians with a direction for increasingly meaningful intervention. Ongoing investigation of our current therapeutics enable clinicians to apply them more judiciously to suitable patients, thereby enhancing the benefit and minimizing the complications of such treatments. Furthermore, by re-evaluating previously disproved treatments through the use of novel regimens or administration routes, promising treatment options are emerging.