Significance of “ultra-early” rebleeding in subarachnoid hemorrhage

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✓ Knowledge of the local incidence of aneurysm rupture permits the conclusion that almost every patient in the population of 933,800 persons served by the authors' institution who was stricken by this catastrophe and survived long enough to be transported was treated at this center (121 patients during 34 months). Of these, 9.1% were admitted late (> 72 hours after subarachnoid hemorrhage (SAH)); of the remaining cases, 94.5% were seen within 24 hours and 50% within 6 hours post-SAH. Of the 121 patients, 10% were neurologically devastated on arrival, a late operation was planned for 19%, and the earliest possible surgery and nimodipine administration was selected for 71%. In this latter group, 50% of the operations were begun within 24 hours and 76% within 48 hours post-SAH. Sixty percent of all mortality and morbidity could be linked to the initial aneurysm bleed. The remaining 40% could be ascribed to potentially avoidable causes of unfavorable outcome. No less than 9.6% of all patients admitted within 24 hours after SAH suffered from “ultra-early” rebleeding during transportation or preparation for operation. The mortality rate from such rebleeding was 7.4%, compared with the 9.1% combined mortality rate from complications and late ischemia.

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Address reprint requests to: Jan Hillman, M.D., Neurosurgical Service, Department of Surgery, University Hospital, S-581 85 Linköping, Sweden.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Diagram dividing the total population of 146 patients into various groups for analysis.

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    Relationship between “ultra-early” repeat hemorrhage and the time distribution of both the patient' arrival at our center and the commencement of surgery, expressed in cumulative percent.

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    Overall outcome of treatment in the entire population of 146 patients suffering aneurysmal rupture.

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