gms | German Medical Science

Objective: Rebleeding from ruptured intracranial aneurysm is a devastating complication of subarachnoid hemorrhage (SAH) leading to high morbidity and mortality. In the present study, the incidence of rebleeding and its related risk factors have been retrospectively analyzed.

Method: We reviewed 105 patients (68 women and 37 men with mean age of 51 years) with SAH who underwent surgical clipping or endovascular occlusion between 2009 - 2011. All clinical data and angiographic characteristics of the aneurysm were examined to detect risk factors for rebleeding before any treatment. Clinical outcome was defined by Glasgow Outcome Scale (GOS).

Results: Significant rehemorrhage occurred in 8 patients (7.6%) before aneurysm treatment; 3 female and 5 male patients with a mean age of 51 years. Three patients died, and another 3 patients sustained severe disabilities (GOS 2-3). The remaining patients showed good recovery 1 year following aneurysm therapy (GOS 4-5). All rebleeding events occurred between 3 - 12 hours after initial SAH except for 1 case (14 days following initial hemorrhage). The majority of patients (n=7) exhibited severe SAH on initial CT scan (Fisher grade IV). In 6 cases, SAH was associated with intracerebral hemorrhage as a result of aneurysm rupture of media cerebral artery (n=3), pericallosal artery (n=2) and anterior communicating artery (n=1). Five aneurysms were greater than 7 mm.

Conclusions: The incidence of rebleeding following aneurysmal SAH is relatively high and the rebleeding mostly occurs within 12 hours. In addition to SAH extent, intracerebral hemorrhage and aneurysm size seem to play a significant role for rebleeding. Because of poor outcome, the importance of early aneurysm therapy is underlined in patients with risk factors for rebleeding.