The benefit of dexamethasone in aneurysmal subarachnoid hemorrhage (SAH) is unproven. This actual study re-examined the impact on complications and outcome. Two hundred and forty-two patient records were analyzed. Dexamethasone had been prescribed individually. Group A consisted of patients in WFNS-grade I to III that were given at least 12 mg/day dexamethasone for at least five days. All other patients in WFNS-grade I to III were assigned to group B. Groups C and D resulted from WFNS-grades IV and V, subdivided according to dexamethasone medication as groups A and B. Hydrocephalus and re-hemorrhage were significantly less frequent in group A than B (19% vs. 37%, P =, and 3% vs. 13%, P =, respectively). Favorable outcomes (Glasgow Outcome Scale, GOS 4 and 5) were more frequent in group A than B (99% vs. 85%; P =). Frequencies of vasospasm and infections did not differ. In groups C and D significant differences were demonstrated for frequencies of hydrocephalus (C: 16%, D: 57%; P =) and complications other than infection (C: 33%, D: 79%; P =). Favorable outcomes were more frequent in group C than D (79% vs. 47%; P =). Frequencies of vasospasm and infections did not differ.