title: Controversies in the management of aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  The care of patients with aneurysmal subarachnoid hemorrhage has evolved significantly with the advent of new diagnostic and therapeutic modalities. Although it is believed that these advances have contributed to improved outcomes, considerable uncertainty persists regarding key areas of management.
  
  
  OBJECTIVE
  To review selected controversies in the management of aneurysmal subarachnoid hemorrhage, with a special emphasis on endovascular vs. surgical techniques for securing aneurysms, the diagnosis and therapy of cerebral vasospasm, neuroprotection, antithrombotic and anticonvulsant agents, cerebral salt wasting, and myocardial dysfunction, and to suggest venues for further clinical investigation.
  
  
  METHODS
  Search of MEDLINE and Cochrane databases and manual review of article bibliographies.
  
  
  CONCLUSIONS
  Many aspects of care in patients with aneurysmal subarachnoid hemorrhage remain highly controversial and warrant further resolution with hypothesis-driven clinical or translational research. It is anticipated that the rigorous evaluation and implementation of such data will provide a basis for improvements in short- and long-term outcomes.
authors.affiliation: Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Neeraj S
authors.initials: NS
authors.lastname: Naval
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.forename: Marek A
authors.initials: MA
authors.lastname: Mirski
authors.forename: Anish
authors.initials: A
authors.lastname: Bhardwaj
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D003422:Critical Care; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents