Induction of hypertension is recommended for patients with DCI unless blood pressure is elevated at baseline or cardiac status precludes it. Class I, Level B Revised 7. Cerebral angioplasty and/or selective intra-arterial vasodilator therapy is reasonable in patients with symptomatic cerebral vasospasm, particularly those who are not rapidly responding to hypertensive therapy. Class IIa, Level B Revised 8. aSAH-associated acute symptomatic hydrocephalus should be managed by cerebrospinal fluid diversion (EVD or lumbar drainage, depending on the clinical scenario). Class I, Level B Revised 9. aSAH-associated chronic symptomatic hydrocephalus should be treated with permanent cerebrospinal fluid diversion. Class I, Level C aSAH indicates aneurysmal subarachnoid hemorrhage; CTA, computed tomography angiography; DSA, digital subtraction angiography; CT, computed tomography; DSA, digital subtraction angiography; EVD, external ventricular drainage; DCI, delayed cerebral ischemia; and WFNS, World Federation of Neurological Surgeons. Connolly et al Management of Aneurysmal Subarachnoid Hemorrhage 1717 reliably categorized by use of simple validated scales, such as the Hunt and Hess and World Federation of Neurological Surgeons scales.69,70 Aneurysm rebleeding is another major predictor of poor outcome, as discussed in a later section. Other factors predictive of poor prognosis include older age, preexisting severe medical illness, global cerebral edema on computed tomography (CT) scan, intraventricular and intra- cerebral hemorrhage, symptomatic vasospasm, delayed cere- bral infarction (especially if multiple), hyperglycemia, fever, anemia, and other systemic complications such as pneumonia and sepsis.71 77 Certain aneurysm factors, such as size, location, and complex configuration, may increase the risk of periprocedural complications and affect overall prognosis.78 Treatment in high-volume centers with availability of neuro- surgical and endovascular services may be associated with Natural History and Outcome of aSAH: Recommendations 1. 