| Clinical Significance of Rebleeding and Risk Factors Affecting Rebleeding in Patients with Spontaneous Subarachnoid Hemorrhages. |
| Hack Gun Bae, Jae Won Do, Kyeong Seok Lee, Il Gyu Yun, Bark Jang Byun |
| Department of Neurosurgery, Soonchunhyang Unversity, Chonan Hospital, Chonan, Korea. |
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| ABSTRACT |
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To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect. |
| Key Words:
Spontaneous subarachnoid hemorrhage; Rebleeding; Mortality; Intracerebral hematoma; Angiography; Ultra-early operation |
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