Repeated lumbar punctures may give rise to a new leakage. (d) Symptomatic treatment - Analgesics and/or diazepam for headache and restlessness.

headache, convulsions or stiff neck. Spinal puncture is done only for diagnostic purposes. Repeated lumbar punctures may give rise to a new leakage. (d) Symptomatic treatment - Analgesics and/or diazepam for headache and restlessness. 2. SURGICAL - for prevention of rebleeding - (a) Direct clipping - of the aneurysm neck - is optimal method of treatment. (b) Trapping - Clipping of proximal and distal vessels for giant aneurysms and intracavernous aneurysms. Prior anastomosis of superficial temporal to middle cerebral artery minimises the risk of isehemic deficit. (c) Wrapping - If clipping is not possible because of the width of the aneurysm or its attachment to adjacent vessels, muslin gauze can be wrapped round the fundus. (d) Induced thrombosis -within the aneurysm sac. Risky and rebleeding may occur. (e) An aneurysm is localised - Ligation of internal carotid or common carotid artery in neck Indications - (i) Young patients with severe initial hemorrhage or early recurrences. (ii) Subdural hematoma following ruptured aneurysm. (iii) Aneurysms arising directly from carotid artery where clipping has failed or not attempted e.g. intracavernous or giant ophthalmic artery aneurysm.