Subarachnoid hemorrhage (SAH) remains a devastating neurological disorder, which most commonly develops after rupture of an intracranial aneurysm. Advances have occurred in the areas of epidemiology, diagnostic imaging, medical management and surgical intervention, related to aneurysmal SAH. Interested physicians must become aware of these and other advances to diagnose and manage this potentially lethal disorder more effectively. This review provides information about the pathogenesis and complications of aneurysmal SAH and an update of new and evolving treatment modalities to provide an in-depth overview for the clinician and researcher involved in this rapidly evolving field.