In 200 consecutive cases of ruptured aneurysms volume of resulting hematomas exceeded 5 ml in 57 patients (28.5%) and 50 ml in 25 patients (12.5%). We have studied the radio anatomical and clinical datas of these 57 cases: In most of them (90%) the aneurysm situation appears to determine hematomas characteristic features. Fatal issues are related to hematoma volume when above 50 ml and to vasospasm in other cases. Results in the 48 operated cases lead to advise neurosurgeons against surgical procedure when volume is greater than 60 ml in grade V patients (unless operation could take place immediately after rupture onset), and when severe intra ventricular hemorrhage is present. Death in ruptured aneurysms is a consequence of hematomas volume in at least 10% cases. Hematomas or vasospasm are responsible for sequellae or fatal issues which still occurs in 15-20% of overall population of patients with ruptured aneurysms, despite improvement in management and timing. Cases finding and preventive surgery of non incidental aneurysms should be a matter of concern.