2000 Volume 28 Issue 6 Pages 454-457
We discuss the risk factor of rebleeding from ruptured cerebral aneurysms with the special emphasis on the interval changes of consciousness level.
We analyzed 129 patients with subarachnoid hemorrhage from ruptured cerebral aneurysms in this study. We recorded and assessed their consciousness level before and on admission by Japan Coma Scale (JCS) and the presence or absence of rebleeding.
Among 71 patients with JCS 100-300 before admission 27 patients (39%) had rebleeding. Among 58 patients with JCS 0-30 before admission, only 1 patient had rebleeding. Therefore, the rebleeding rate of the patients with pre-hospital JCS 0-30 was significantly lower than those with pre-hospital JCS 100-300. On the other hand, the number of the patients with JCS 100-300 on admission was 52, and 17 (32.8%) had rebleeding. Among 77 patients with JCS 0-30 on admission, 11 (14.2%) had rebleeding. A comparison of the rebleeding rate of the patients with JCS 0-30 on admission with that of the patients with pre-hospital JCS 0-30 showed that the rebleeding rate of the patients with admission JCS 0-30 was significantly higher. All 11 patients who had JCS 0-30 on admission and developed rebleeding had pre-hospital JCS 100-300. In other words, none of the patients with both pre-hospital and admission JCS 0-30 had rebleeding.
The patients whose consciousness level was once as bad as JCS 100-300 and then recovered to as good as JCS 0-30 had a high risk of rebleeding. Taking the pre-hospital history of patients with subarachnoid hemorrhage in detail provides us important and useful information for preventing rebleeding from ruptured cerebral aneurysms.
