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% 1).
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
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 2).