Study on early re-rupture of intracranial aneurysms

The prognosis of patients with early re-ruptured intracranial aneurysms is discouraging. We compared the data on patients suffering re-rupture before the onset of late vasospasm (Early-Re) with those suffering rebleeding thereafter (Late-Re). The operability in the Early-Re group was lower (p < 0.05) and the outcome less satisfactory than that of Late-Re group. Of the Early-Re patients, 83% had a re-rupture within 24 hours of the initial subarachnoid haemorrhage; moreover 46% of these experienced rebleeding within three hours of the initial bleeding. Cases in the Early-Re group tended to belong to Hunt-Hess grade III or IV on admission, of wide spread subarachnoid haemorrhage on CT and of "bump" type aneurysms on angiograms. Based on our experience we propose that early re-rupture may be attributable to the following factors: a gradual and progressive thinning of the wall of bump type aneurysms results in such a large laceration through the fundus of the aneurysm. Re-rupture may occur within a short period after the first rupture because the fibrin net covering the wide laceration cannot tolerate the slight increase in internal pressure within the aneurysmal dome. Therefore, in the patients of Hunt-Hess grade III or IV, conventional angiography, tight holding during CT examination and lumbar puncture, should be avoided during the first three hours after the first bleed. Although early direct operations on patients with high Hunt-Hess grades tend to produce an unsatisfactory outcome, we cannot help these patients with Early-Re without surgical treatment. Not only early direct operation but also first conservative treatment to control systolic blood pressure are very important in patients with Early-Re.