Rebleeding of ruptured intracranial aneurysms in the acute stage

Abstract

Among the cases of ruptured aneurysms we have handled, some patients have rebled before surgery was performed. In this study, we examine the factors that contribute to the rerupture of cerebral aneurysms in the acute stage and suggest measures to prevent rerupture prior to surgery. We have encountered 32 cases of rebleeding prior to surgery. The rebleeding occurred within six hours of the initial subarachnoid hemorrhage (SAH) in 26 patients, among whom 21 rebled within three hours. Thirteen patients rebled during bed rest, 10 patients during angiography, 4 patients during CT scan and 5 patients in various other circumstances. Nine of the 10 patients who rebled during angiography had undergone the procedure within three hours of the initial SAH. Overall, the patients' condition deteriorated substantially after rebleeding. Considering these circumstances surrounding aneurysmal rerupture, we suggest the following measures for the prevention of preoperative rerupture in the acute stage: 1) maintenance of lowered blood pressure during the risky period; 2) intentional delay of performance of angiography until at least hours after the initial rupture; and 3) performance of surgery on an emergency basis.