Management

• Maintain adequate hydration, nutrition, analgesia, sedation.

• Cerebral vasospasm is prevented by nimodipine infusion and maintenance of a full intravascular volume.

• Systemic hypertension should only be treated if severe (e.g. systolic pressure >220-230 mmHg) and prolonged.

• Surgery—the timing is controversial with either early or delayed (7-10 days) intervention being advocated. The Regional Neurosurgical Centre should be consulted for local policy.

• Antifibrinolytic therapy (e.g. tranexamic acid) reduces the incidence of rebleeding but has no beneficial effect on outcome.

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