The majority of patients survive the first dangerous hours after an aneurysmal rupture. However, many subsequently succumb as a result of a variety of lethal complications. The most important of these develop as sequelae of the initial ischemia, rebleeding and the delayed onset of vasospasm. Some of these deleterious cascades can be aborted. Since the delayed complications such as vasospastic infarction can be accurately predicted, this is one of rare “strokes” that can have pharmacological pre-treatment. The natural history of rebleeding and vasospasm are described as well as their effects on blood flow, oxygen delivery and metabolism. Strategies to ameliorate acute and delayed ischemia and hypoxia are discussed. Finally, potential pharmacotherapies are detailed.