Intracranial aneurysms cause in excess of 28,000 subarachnoid hemorrhages per year in North America. The combined mortality and morbidity from aneurysmal subarachnoid hemorrhage exceeds 40%, and therefore yields a remarkably high toll of human and economic loss. As a lesion that is treatable, even curable at particular stages, management decisions are critical. In spite of significant advances in surgical technique, the mortality rate remains high. Erroneous diagnosis in good-grade patients significantly contributes to the lack of improvement in current statistics. Diagnosis and subsequent contemporary management is discussed.