====== Intracranial aneurysm rebleeding ======

[[Aneurysm]] [[rerupture]] prior to treatment is a major cause of [[death]] and [[morbidity]] in [[aneurysmal subarachnoid hemorrhage]]. 

see [[Intracranial aneurysm rerupture after treatment]].

see [[Aneurysm rebleeding from clipped aneurysm]]

[[Rebleeding]] is an important cause of [[death]] and disability in people with [[aneurysmal subarachnoid hemorrhage]]. Rebleeding is probably related to dissolution of the blood clot at the site of aneurysm rupture by natural fibrinolytic activity. 

For patients having an aneurysmal rupture after treatment, the mortality rate in the CARAT study was 58%
((Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR: Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms: the Cerebral Aneurysm Rerupture After Treatment (CARAT) study. Stroke 39:120–125, 2008)).

Rebleeding is the most imminent danger.

Among patients surviving the initial hemorrhage treated without surgery, rebleeding is the major cause of morbidity and mortality, the risk is 15-20% within 2 Weeks. The goal of early surgery is to reduce this risk.

===== Risk factors =====

[[Intracranial aneurysm rebleeding risk factors]].

====Case series====
===2016===
A total of 99 patients with aneurysmal rebleed were analyzed in this study both prospectively and retrospectively from August 2010 to July 2014. In the control group, 100 patients were selected randomly from the patient registry. A total of 25 variables from the demographic, historical, clinical and radiological data were compared and analyzed by univariate and multivariate logistic regression analysis.

Significant independent predictors of aneurysm rebleed were the presence of known hypertension (p = 0.023), diastolic blood pressure of >90 mmHg on admission (p = 0.008); presence of loss of consciousness (p = 0.013) or seizures (p = 0.002) at first ictus; history of warning headaches (p = 0.005); higher Fisher grade (p < 0.001); presence of multiple aneurysms (p = 0.021); irregular aneurysm surface (0.002).

Identification of high risk factors can help in stratifying patients in the high risk group. The risk stratification strategy with early intervention can prevent rebleeds. This in turn may translate into better outcomes of patients with intracranial aneurysms
((Solanki C, Pandey P, Rao KV. Predictors of aneurysmal rebleed before
definitive surgical or endovascular management. Acta Neurochir (Wien). 2016
Jun;158(6):1037-44. doi: 10.1007/s00701-016-2784-6. Epub 2016 Apr 11. PubMed
PMID: 27068042.
)).