Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating condition with high mortality and morbidity rates. Early brain injury, rebleeding, and delayed cerebral ischemia (DCI) are key determinants of poor outcomes. Prompt diagnosis, transfer to specialized centers, and intensive care management have significantly improved prognosis. Multimodal monitoring and interventions to correct pathophysiological imbalances are crucial. Challenges remain due to limited robust clinical evidence. This review provides an updated guide for intensivists, covering epidemiology, initial stabilization, treatment strategies, long-term prognostic factors, and post-aSAH complications. It emphasizes the importance of timely aneurysm securing, systemic monitoring, and multidisciplinary team collaboration. The review also discusses specific complications such as hydrocephalus, seizures, intracranial hypertension, and extracranial complications, offering practical clinical guidance based on current evidence and expert experience.Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating condition with high mortality and morbidity rates. Early brain injury, rebleeding, and delayed cerebral ischemia (DCI) are key determinants of poor outcomes. Prompt diagnosis, transfer to specialized centers, and intensive care management have significantly improved prognosis. Multimodal monitoring and interventions to correct pathophysiological imbalances are crucial. Challenges remain due to limited robust clinical evidence. This review provides an updated guide for intensivists, covering epidemiology, initial stabilization, treatment strategies, long-term prognostic factors, and post-aSAH complications. It emphasizes the importance of timely aneurysm securing, systemic monitoring, and multidisciplinary team collaboration. The review also discusses specific complications such as hydrocephalus, seizures, intracranial hypertension, and extracranial complications, offering practical clinical guidance based on current evidence and expert experience.