Rebleeding of Ruptured Intracranial Aneurysm in the Acute Stage

Abstract

Rebleeding was analyzed in 396 patients admitted to our institute within 6 hours of aneurysmal subarachnoid hemorrhage (SAH) attack during the 14-year period from 1981 to 1994. Rebleeding occurred in 51 of these cases. The mean age was 61 years and the female/male ratio was 1.3: 1. The site of the ruptured aneurysm was most often located in the anterior communicating arteries. Thirty-five patients rebleed within 6 hours after the initial attack, accounting for 69%of all rebleeding cases.
Rebleeding occurred in 20 cases during cerebral angiography, and in 24 cases prior to angiography. Eighty-five percent of rebleeding occurred at a systolic blood pressure over 140mmHg. Mortality in the rebleeding cases was 71%and the neurological grade worsened after rebleeding. Rebleeding is thus an important factor influencing the prognosis of SAH.
The results of this analysis suggest that rebleeding can be prevented by lowering blood pressure before surgery and performing emergency surgery as soon as possible after the diagnosis of SAH.