What are the goals of treatment for a subarachnoid hemorrhage?

• A. Locate the site of bleeding and repair; manage complications (hydrocephalus, hyponatremia, seizures, increased ICP)
• B. Stabilize blood sugar and treat infection
• C. Increase blood pressure and diuresis
• D. Focus solely on symptom relief

Answer: (A)

Management of a subarachnoid hemorrhage centers on locating and securing the bleeding source to prevent rebleeding, which is the immediate life threat. Once the aneurysm or rupture is controlled, the focus is on preventing and treating complications that drive morbidity and mortality. This includes addressing hydrocephalus from blood obstructing CSF pathways, correcting hyponatremia and fluid imbalances, preventing or treating seizures, and managing increased intracranial pressure. Additional measures aim to reduce the risk of delayed cerebral ischemia from vasospasm, often with medications like nimodipine and careful neurological monitoring. Stabilization and careful vascular control precede any efforts to relieve symptoms, and close attention to these processes is essential for better outcomes.