With an incidence of 2–22/100.000/ year, the aneurysmatic subarachnoid haemorrhage (SAH) is a rare but serious neurovascular disease. Depending on the severity of the haemorrhage, up to 93 % of patients suffer from a poor neurologic outcome. The acute symptoms are often unspecific and range from mild headache to coma. To verify SAH, cerebral computer tomography with angiography is the diagnostic tool of choice. In many cases the underlying aneurysm can be displayed as well. Due to the risk of rebleeding, securing the aneurysm within 72 hours via clipping or coiling is mandatory. Internal hydrocephalus often follows SAH and requires external ventricular drainage. Throughout the course, specific complications like delayed cerebral ischaemia determine the morbidity and mortality of the patient. Until today, only few beneficial evidence-based therapeutic options exist. The article summarises the current literature and gives therapeutic recommendations.