Aneurysmal subarachnoid hemorrhage is a devastating condition, with an estimated death rate of 30% during the initial episode. 1,2 Approximately the same number of patients survive but leave the hospital with disabling neurologic deficits. 3 However, better outcomes can be achieved by systems that are able to work as a team on the collective goal of quick intervention to secure the ruptured aneurysm, followed by the implementation of measures to minimize secondary brain injury. Although the search for new diagnostic, prognostic, and therapeutic modalities continues, it is clear that there exists no " silver bullet " that will help all patients. Instead, it is the systematic integration and application of small advances that will ultimately maximize the patient's chances of survival and neurologic recovery. This review focuses on the management of aneurysmal subarachnoid hemorrhage and its systemic and neurologic complications. ■ ANEURYSM IS THE MOST COMMON CAUSE OF SUBARACHNOID BLEEDING Aneurysmal subarachnoid hemorrhage, ie, rupture of an intracranial aneurysm, flooding the subarachnoid space with blood, affects about 24,000 Americans each year. 1,2 A ruptured aneurysm is the most common cause of subarachnoid hemorrhage, accounting for about 85% of cases. Less common causes include idiopathic benign perimesencephalic ABSTRACT Patients with aneurysmal subarachnoid hemorrhage are at high risk of complications, including rebleeding, delayed cerebral ischemia, cerebral infarction, and death. This review presents a practical approach for managing this condition and its complications.