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Marvin Darkwah Oppong, Meltem Gümüs, Daniela Pierscianek, Annika Herten, Andreas Kneist, Karsten Wrede, Lennart Barthel, Michael Forsting, Ulrich Sure, and Ramazan Jabbarli

A neurysm rebleeding before therapy is the most relevant preventable cause of death after subarachnoid hemorrhage (SAH). 6 Furthermore, it is one of the main causes of poor outcome in surviving patients. 28 Both the European Stroke Organization 30 and American Stroke Association 11 have recently issued guidelines recommending aneurysm occlusion in the first 72 hours after ictus (early treatment) as long it is feasible in light of the patient’s condition. Rebleeding rates are still reported to be between 7% and 21%. 5 , 33 The first 24 hours after initial

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Yukihiko Fujii, Shigekazu Takeuchi, Osamu Sasaki, Takashi Minakawa, Tetsuo Koike, and Ryuichi Tanaka

R ecently , intensive research has been undertaken to improve the clinical outcome of patients with spontaneous subarachnoid hemorrhage (SAH). 4, 9, 24, 26, 31, 32, 35 Rebleeding in particular has been well investigated, 3, 20, 21, 25, 30 and it is now recognized that early operation can prevent rebleeding that occurs within the first several days of onset. However, ultra-early rebleeding, which may occur prior to early operation, remains a serious problem by worsening the clinical outcome of patients with SAH. To date, few reports have focused on ultra

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Nobutaka Horie, Shuntaro Sato, Makio Kaminogo, Yoichi Morofuji, Tsuyoshi Izumo, Takeo Anda, and Takayuki Matsuo

P reoperative aneurysm rebleeding has historically been an important cause of morbidity and mortality after subarachnoid hemorrhage (SAH) and is estimated to occur in about 5.8% to 19.3% of patients after initial SAH. 10 , 29 , 32 , 33 Some predictive factors for preoperative rebleeding have been identified and might help to allow recognition of patients who will benefit from acute treatment. 1 , 3 , 6 , 12 , 17 , 18 , 25 , 27 However, these risk factors are somewhat controversial because of the small sample sizes on which these studies have been based. 18

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Vini G. Khurana, David G. Piepgras, and Jack P. Whisnant

A pproximately 5% of all aneurysms are giant aneurysms, which by definition measure 25 mm or more in diameter. 27 Approximately 25% of giant aneurysms present clinically with subarachnoid hemorhage (SAH). 18, 19 Wiebers, et al., 30 suggested that unruptured giant and near-giant aneurysms have a higher probability of subsequent rupture than smaller ones. Thrombosis of the lesion, which may be extensive in giant aneurysms, does not preclude rupture. 12, 22 Although the incidence of rebleeding from smaller aneurysms has been studied extensively, 5, 8, 9, 14, 15

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Jarl Rosenørn, Lars Westergaard, and Peter H. Hansen

communicating artery, with the dome of the aneurysm located under the right frontal lobe. On the 8th day after admission, the patient had a clinical condition corresponding to Grade III of Hunt and Hess, 6 and was considered to be fit for surgery. Mean arterial blood pressure (MABP) was recorded continuously during the operation. Operation . A right frontal craniotomy was performed. The MABP was between 95 and 90 mm Hg from the beginning of the operation until a few seconds after rebleeding. After the bone flap was removed, the dura was found to be tense, and 50 gm of

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Chifumi Kitanaka, Tadashi Morimoto, Tomio Sasaki, and Kintomo Takakura

A n increasing number of surgically treated cases of vertebral artery dissection are currently being reported. The accepted surgical technique for such cases is proximal clipping of the dissected vertebral artery; trapping of a dissected artery has rarely been performed. Fortunately, there have been no reports of rebleeding after appropriate proximal clipping. We present a case of vertebral artery dissection that rebled in spite of appropriate proximal clipping. This case indicates that the surgeon should exercise caution in treating vertebral artery

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Jon I. McIver, Jonathan A. Friedman, Eelco F. M. Wijdicks, David G. Piepgras, Mark A. Pichelmann, L. Gerard Toussaint III, Robyn L. McClelland, Douglas A. Nichols, and John L. D. Atkinson

R ecurrent hemorrhage is an important source of morbidity after initial rupture of an intracranial aneurysm. 1, 13 Theoretically, CSF drainage in patients with an unsecured, recently ruptured cerebral aneurysm may increase transmural pressure across the aneurysm wall, thereby increasing the likelihood of recurrent hemorrhage. 9 Despite the widespread use of ventriculostomy for the treatment of acute hydrocephalus after aneurysmal SAH, there is no consensus regarding the risk of rebleeding when ventriculostomy is performed before aneurysm repair. This

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Jan Hillman, Claes von Essen, Waclaw Leszniewski, and Ingegerd Johansson

delayed in local hospitals in this region. All of the remaining 110 patients were admitted to this center within 72 hours after bleeding (see below). Twelve of these cases admitted early were scheduled for a delayed operation. Most of these delayed cases were treated at the beginning of the study but, as we have gained experience with early operation in older patients, only occasionally is surgery now delayed for random technical reasons. Two severe rebleeding episodes could have been prevented in this group with early operation, and nimodipine treatment may have

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Seppo Juvela and Marrku Kaste

R educed platelet aggregability has been reported after subarachnoid hemorrhage (SAH); however, it is not known whether this precedes or follows SAH and an association with rebleeding remains a possibility. 19 Platelets accumulate on the intimal surface of arteries after experimental SAH, 4 which could lead to fewer remaining active platelets in the circulation. This can be detected as reduced platelet function after SAH, 19 and may be one reason why rebleeding occurs most frequently during the 1st day after primary SAH, 1, 11, 12 when the platelet plug

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Laura Paré, Ralph Delfino, and Richard Leblanc

A neurysmal rerupture is a leading cause of death and disability in cases of subarachnoid hemorrhage (SAH) due to aneurysms. The cumulative incidence of aneurysmal rerupture may be as high as 27.7%, with the peak occurring in the first 24 hours. 17, 19, 21, 26 The mortality rate in patients with recurrent hemorrhage ranges from 60% to 80%, 1, 17, 19, 28 with rebleeding accounting for nearly 26% of all deaths reported by the International Cooperative Study. 22 Despite their clinical importance, the risk factors of aneurysmal rerupture are not clearly