Rebleeding of ruptured intracranial aneurysms in the acute stage

Abstract

We analyzed early aneurysmal rebleeding in 150 consecutive patients who suffered an aneurysmal subarachnoid hemorrhage (SAH) and who were admitted within 6 hours of the initial SAH. Of these patients, 33 patients rebled. The first rebleed occurred within 24 hours in 29 patients, among whom 23 cases rebled within 6 hours. The rebleeding rate within 6 hours after the initial SAH was not related to age or sex of the patient; blood pressure on admission; size, shape, or site of aneurysm; or presence or absence of intracerebral hematoma or intraventricular hemorrhage on computed tomography (CT) scan. The patients' clinical condition and SAH on CT scan were graded I-V. Evaluation of rebleeding of those patients with grade V was difficult. In examining the rebleeding rate in grades I-IV, the higher the grade, the greater the rebleeding. Rebleeding developed during angiography conducted within 6 hours from the initial SAH in four cases. This is approximately twofold higher than the rebleeding rate within 6 hours for the total series. It is concluded that rebleeding in the acute stage is predominant within 6 hours from the initial SAH and that this rebleeding rate is higher the more severe the initial SAH is.