Rebleeding from ruptured intracranial aneurysms

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition often complicated by rebleeding.
• Understanding rebleeding patterns is crucial for improving patient outcomes after aSAH.

Purpose of the Study:

• To determine the incidence and timing of rebleeding in patients with confirmed aneurysmal subarachnoid hemorrhage.
• To assess the mortality rate and functional outcomes associated with rebleeding events.

Main Methods:

• Prospective analysis of 236 consecutive patients admitted with aneurysmal subarachnoid hemorrhage within 72 hours.
• Rebleeding was defined by sudden loss of consciousness and confirmed by CT, autopsy, lumbar puncture, or angiography.
• Follow-up was conducted for at least 6 months, with some patients followed for a mean of 3 years.

Main Results:

• Twenty-two point five percent (53/236) of patients experienced at least one rebleed within 6 months.
• The peak incidence of rebleeding occurred within the first 24 hours and at the end of the first week post-aSAH.
• The mortality rate for patients with rebleeding was 74%, with only 19% achieving a good outcome.

Conclusions:

• Rebleeding is a significant cause of mortality and poor functional outcome in aneurysmal subarachnoid hemorrhage patients.
• The critical period for rebleeding is within the first week, emphasizing the need for immediate and intensive management.
• Patient's admission grade, age, and sex did not influence the incidence or timing of rebleeding.