The risk of rebleeding from ruptured intracranial aneurysms

Restricted access

✓ In the 5-year period from 1978 to 1983, 1076 patients with ruptured intracranial aneurysms were admitted to the six neurosurgical departments in Denmark and were entered in a prospective consecutive study conducted by the Danish Aneurysm Study Group. The patients were followed with 3-month and 2-year examinations or to death. A total of 133 patients suffered at least one rebleed after their initial hemorrhage during their first stay in the neurosurgical department; these patients had a mortality rate of 80% compared to 41 % for patients without a rebleed (p < 0.0001). During the first 2 weeks after the initial insult, 102 rebleeds were registered. The daily rate of rebleeds during these 2 weeks, calculated using a life-table method, varied from 0.2% to 2.1%. The rebleed rate during the first 24 hours (Day 0) was 0.8%, and the maximum risk of rebleeding was observed between Day 4 and Day 9. Significantly fewer rebleeds were reported in patients with good clinical grades (Grades 1 to 3, Hunt Grades I and II) compared to those with poor clinical grades (Grades 4 to 9, Hunt Grades III to V: p < 0.001).

Article Information

Address reprint requests to: Jarl Rosenørn, M.D., University Clinic of Neurosurgery, Copenhagen County Hospital, DK-2600 Glostrup, Denmark.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Daily (left) and cumulative (right) rates of rebleeding from a ruptured aneurysm in a total group of 1076 patients (437 in clinical Grades 1 to 3 and 639 in clinical Grades 4 to 9). SAH = subarachnoid hemorrhage.

References

1.

Adams HPKassell NFTorner JCet al: Early management of aneurysmal subarachnoid hemorrhage. J Neurosurg 54:1411451981Adams HP Kassell NF Torner JC et al: Early management of aneurysmal subarachnoid hemorrhage. J Neurosurg 54:141–145 1981

2.

Armitage P: Statistical Methods in Medical Research. Oxford: Blackwell Scientific Publications1972 pp 408414Armitage P: Statistical Methods in Medical Research. Oxford: Blackwell Scientific Publications 1972 pp 408–414

3.

Da Pian RPasqualin AScienza Ret al: Early surgery for intracranial aneurysms: influence of clinical and operative findings on final results in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter1985 pp 115124Da Pian R Pasqualin A Scienza R et al: Early surgery for intracranial aneurysms: influence of clinical and operative findings on final results in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter 1985 pp 115–124

4.

Drake CG: Management of cerebral aneurysm. Stroke 12:2732831981Drake CG: Management of cerebral aneurysm. Stroke 12:273–283 1981

5.

Hunt WE: Grading of risk in intracranial aneurysms in Sano KIshii S (eds): Recent Progress in Neurological Surgery. International Congress Series No. 320. Amsterdam: Excerpta Medica1974 pp 169176Hunt WE: Grading of risk in intracranial aneurysms in Sano K Ishii S (eds): Recent Progress in Neurological Surgery. International Congress Series No. 320. Amsterdam: Excerpta Medica 1974 pp 169–176

6.

Jane JAWinn HRRichardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 24:1761841977Jane JA Winn HR Richardson AE: The natural history of intracranial aneurysms: rebleeding rates during the acute and long term period and implication for surgical management. Clin Neurosurg 24:176–184 1977

7.

Kassell NFAdams HPBoarini DJet al: Results of early surgery for ruptured intracranial aneurysm in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter1985 pp 177182Kassell NF Adams HP Boarini DJ et al: Results of early surgery for ruptured intracranial aneurysm in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter 1985 pp 177–182

8.

Kassell NFBoarini DJAdams HPet al: Overall management of ruptured aneurysm: comparison of early and late operation. Neurosurgery 9:1201281981Kassell NF Boarini DJ Adams HP et al: Overall management of ruptured aneurysm: comparison of early and late operation. Neurosurgery 9:120–128 1981

9.

Kassell NFDrake CG: Timing of aneurysm surgery. Neurosurgery 10:5145191982Kassell NF Drake CG: Timing of aneurysm surgery. Neurosurgery 10:514–519 1982

10.

Kassell NFTorner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:4794811983Kassell NF Torner JC: Aneurysmal rebleeding: a preliminary report from the Cooperative Aneurysm Study. Neurosurgery 13:479–481 1983

11.

Kassell NFTorner JCAdams HP: Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage. Preliminary observations from the Cooperative Aneurysm Study. J Neurosurg 61:2252301984Kassell NF Torner JC Adams HP: Antifibrinolytic therapy in the acute period following aneurysmal subarachnoid hemorrhage. Preliminary observations from the Cooperative Aneurysm Study. J Neurosurg 61:225–230 1984

12.

Ljunggren BBrandt LKågström Eet al: Results of early operations for ruptured aneurysms. J Neurosurg 54:4734791981Ljunggren B Brandt L Kågström E et al: Results of early operations for ruptured aneurysms. J Neurosurg 54:473–479 1981

13.

Ljunggren BSäveland HBrandt L: Causes of unfavorable outcome after early aneurysm operation. Neurosurgery 13:6296331983Ljunggren B Säveland H Brandt L: Causes of unfavorable outcome after early aneurysm operation. Neurosurgery 13:629–633 1983

14.

Locksley HB: Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study in Sahs ALPerret GELocksley HBet al (eds): Intracranial Aneurysms and Subarachnoid Hemorrhage. A Cooperative Study. Philadelphia: JB Lippincott1969 pp 37108Locksley HB: Natural history of subarachnoid hemorrhage intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the Cooperative Study in Sahs AL Perret GE Locksley HB et al (eds): Intracranial Aneurysms and Subarachnoid Hemorrhage. A Cooperative Study. Philadelphia: JB Lippincott 1969 pp 37–108

15.

Maurice-Williams RS: Ruptured intracranial aneurysms: has the incidence of early rebleeding been over-estimated? J Neurol Neurosurg Psychiatry 45:7747791982Maurice-Williams RS: Ruptured intracranial aneurysms: has the incidence of early rebleeding been over-estimated? J Neurol Neurosurg Psychiatry 45:774–779 1982

16.

Nibbelink DWKnowler LA: Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Report on a randomized treatment study. II. Objectives and design of randomized aneurysm study. Stroke 5:5525561974Nibbelink DW Knowler LA: Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Report on a randomized treatment study. II. Objectives and design of randomized aneurysm study. Stroke 5:552–556 1974

17.

Nibbelink DWTorner JCHenderson WG: Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage. Stroke 6:6226291975Nibbelink DW Torner JC Henderson WG: Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage. Stroke 6:622–629 1975

18.

Pakarinen S: Incidence, aetiology, and prognosis of primary subarachnoid haemorrhage. A study based on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 43 (Suppl 29): 11281967Pakarinen S: Incidence aetiology and prognosis of primary subarachnoid haemorrhage. A study based on 589 cases diagnosed in a defined urban population during a defined period. Acta Neurol Scand 43 (Suppl 29):1–128 1967

19.

Pertuiset BSichez JPSermet Aet al: Rate and causes of mortality related to the timing of open surgery in ruptured supratentorial aneurysms (series of 143 cases operated by 5 neurosurgeons) in Auer LA (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter1985 pp 217226Pertuiset B Sichez JP Sermet A et al: Rate and causes of mortality related to the timing of open surgery in ruptured supratentorial aneurysms (series of 143 cases operated by 5 neurosurgeons) in Auer LA (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter 1985 pp 217–226

20.

Phillips LH IIWhisnant JPO'Fallon WMet al: The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30:103410401980Phillips LH II Whisnant JP O'Fallon WM et al: The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30:1034–1040 1980

21.

Ramirez-Lassepas M: Antifibrinolytic therapy in subarachnoid hemorrhage caused by ruptured intracranial aneurysm. Neurology 31:3163221981Ramirez-Lassepas M: Antifibrinolytic therapy in subarachnoid hemorrhage caused by ruptured intracranial aneurysm. Neurology 31:316–322 1981

22.

Rasmussen PBusch HHaase Jet al: Intracranial saccular aneurysms. Results of treatment in 851 patients. Acta Neurochir 53:1171980Rasmussen P Busch H Haase J et al: Intracranial saccular aneurysms. Results of treatment in 851 patients. Acta Neurochir 53:1–17 1980

23.

Rosenørn JEskesen VSchmidt Ket al: Clinical features and outcome in 1076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg 1:33461987Rosenørn J Eskesen V Schmidt K et al: Clinical features and outcome in 1076 patients with ruptured intracranial saccular aneurysms: a prospective consecutive study. Br J Neurosurg 1:33–46 1987

24.

Samson DSHodosh RMReid WRet al: Risk of intracranial aneurysm surgery in the good grade patient: early versus late operation. Neurosurgery 5:4224261979Samson DS Hodosh RM Reid WR et al: Risk of intracranial aneurysm surgery in the good grade patient: early versus late operation. Neurosurgery 5:422–426 1979

25.

Sano K: Timing of surgery, operative mortality, and follow-up results in cases with subarachnoid hemorrhage due to aneurysm rupture in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter1985 pp 227236Sano K: Timing of surgery operative mortality and follow-up results in cases with subarachnoid hemorrhage due to aneurysm rupture in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter 1985 pp 227–236

26.

Sundt TM JrKobayashi SFode NCet al: Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. J Neurosurg 56:7537651982Sundt TM Jr Kobayashi S Fode NC et al: Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. J Neurosurg 56:753–765 1982

27.

Suzuki JHori S: Prediction of reattacks following rupture of intracranial aneurysms. Neurol Med Chir 15 (Part I):35391975Suzuki J Hori S: Prediction of reattacks following rupture of intracranial aneurysms. Neurol Med Chir 15 (Part I):35–39 1975

28.

Suzuki JOnuma TYoshimoto T: Results of early operations on cerebral aneurysms. Surg Neurol 11:4074121979Suzuki J Onuma T Yoshimoto T: Results of early operations on cerebral aneurysms. Surg Neurol 11:407–412 1979

29.

Vapalahti MLjunggren BSäveland Het al: Early aneurysm operation and outcome in two remote Scandinavian populations. J Neurosurg 60:116011621984Vapalahti M Ljunggren B Säveland H et al: Early aneurysm operation and outcome in two remote Scandinavian populations. J Neurosurg 60:1160–1162 1984

30.

Vermeulen MLindsay KWMurray GDet al: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311:4324371984Vermeulen M Lindsay KW Murray GD et al: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311:432–437 1984

31.

Vermeulen Mvan Gijn JHijdra Aet al: Causes of acute deterioration in patients with a ruptured intracranial aneurysm. A prospective study with serial CT scanning. J Neurosurg 60:9359391984Vermeulen M van Gijn J Hijdra A et al: Causes of acute deterioration in patients with a ruptured intracranial aneurysm. A prospective study with serial CT scanning. J Neurosurg 60:935–939 1984

32.

Weir BAronyk K: Management mortality and the timing of surgery for supratentorial aneurysms. J Neurosurg 54:1461501981Weir B Aronyk K: Management mortality and the timing of surgery for supratentorial aneurysms. J Neurosurg 54:146–150 1981

33.

Weir BPetruk KDisney Let al: Management mortality related to the timing of surgery for anterior circulation aneurysms in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter1985 pp 165176Weir B Petruk K Disney L et al: Management mortality related to the timing of surgery for anterior circulation aneurysms in Auer LM (ed): Timing of Aneurysm Surgery. Berlin: Walter de Gruyter 1985 pp 165–176

34.

Winn HRAlmaani WSBerga SLet al: The long-term outcome in patients with multiple aneurysms. J Neurosurg 59:6426511983Winn HR Almaani WS Berga SL et al: The long-term outcome in patients with multiple aneurysms. J Neurosurg 59:642–651 1983

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 141 141 39
Full Text Views 269 269 15
PDF Downloads 148 148 7
EPUB Downloads 0 0 0

PubMed

Google Scholar