Significance of “ultra-early” rebleeding in subarachnoid hemorrhage

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

doi:10.3171/jns.1988.68.6.0901

Cited by 80 publications

(33 citation statements)

References 47 publications

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“…2,3,7,8,10,[12][13][14][15][16][17][18][19][20]22,23,25,35 We refer to all treatment after the first 24 hours as delayed, a group that encompassed the previously defined early, intermediate, and late timings. Eighty-eight percent of the delayed group were treated between 1 and 3 days post-ictus.…”

Section: Discussionmentioning

confidence: 99%

Does Treatment of Ruptured Intracranial Aneurysms Within 24 Hours Improve Clinical Outcome?

Phillips

Dowling

Yan

et al. 2011

Stroke

137

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Background and Purpose-The purpose of this study was to analyze whether treating ruptured intracranial aneurysms within 24 hours of subarachnoid hemorrhage improves clinical outcome. Methods-An 11-year database of consecutive ruptured intracranial aneurysms treated with endovascular coiling or craniotomy and clipping was analyzed. Outcome was measured by the modified Rankin Scale at 6 months. Our policy is to treat all cases within 24 hours of subarachnoid hemorrhage. Treatment delays are due to nonclinical logistical factors. Results-Two hundred thirty cases were coiled or clipped within 24 hours of subarachnoid hemorrhage and 229 at Ͼ24 hours.No difference in age, gender, smoking, family history of subarachnoid hemorrhage, aneurysm size, or aneurysm location was found between the groups. Poor World Federation of Neurological Surgeons clinical grade patients were overrepresented in the ultra-early group. Increasing age and higher World Federation of Neurological Surgeons clinical grade were predictors of poor outcome. Eight point zero percent of cases treated within 24 hours of subarachnoid hemorrhage (ultra-early) were dependent or dead at 6 months compared with 14.4% of those treated at Ͼ24 hours (delayed), a 44.0% relative risk reduction and a 6.4% absolute risk reduction (

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Section: Discussionmentioning

confidence: 99%

Does Treatment of Ruptured Intracranial Aneurysms Within 24 Hours Improve Clinical Outcome?

Phillips

Dowling

Yan

et al. 2011

Stroke

137

View full text Add to dashboard Cite

show abstract

“…Recent data from pre-clinical and clinical studies have supported the relative safety of blood pressure reduction in acute intracerebral hemorrhage, although the benefit remains unclear [32,33]. Patients with subarachnoid hemorrhage remain at risk of second rupture acutely following an initial rupture of intracranial aneurysm [34]. The benefit of reduction of blood pressure has been linked to reduction of hemodynamic stress on aneurysm wall and prevention of second rupture.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Qureshi¹,

Ezzeddine²,

Nasar³

et al. 2007

The American Journal of Emergency Medicine

390

245

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Purpose-To estimate the prevalence of elevated blood pressure in adult patients with acute stroke in the United States (U.S.).Methods-Stroke patients were classified by initial systolic blood pressure into four categories using demographic, clinical, and treatment data from the National Hospital Ambulatory Medical Care Survey, the largest study of utilization and provision of emergency department services in the U.S. We also compared the age-, sex-, and ethnicity-adjusted rates of elevated blood pressure strata comparable with stages 1 and 2 hypertension in the U.S. population.Results-Of the 563,704 stroke patients evaluated, initial systolic blood pressure was <140 mm Hg in 173,120 patients (31%), 140-184 mm Hg in 315,207 patients (56%), 185-219 mm Hg in 74,586 patients (13%), and ≥220 mm Hg in 791 patients (0.1%). The mean time interval between presentation and evaluation was 40 ± 55, 33 ± 39, 25 ± 27, and 5 ± 1 minutes for increasing systolic blood pressure strata (p=0.009). A 3-and 8-fold higher rate of elevated blood pressure strata was observed in acute stroke than the existing rates of stages 1 and 2 hypertension in the U.S. population. Labetalol and hydralazine were used in 6,126 (1%) and 2,262 (0.4%) patients, respectively. Thrombolytics were used in 1,283 patients (0.4%), but only in those with SBP of 140-184 mm Hg.Conclusions-In a nationally representative large dataset, elevated blood pressure was observed in over 60% of the patients presenting with stroke to the emergency department. Elevated blood pressure was associated with an earlier evaluation, however, the use of thrombolytics was restricted to ischemic stroke patients with systolic blood pressure <185 mm Hg.

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“…Hillman et al 17 reported that in 121 patients with aneurysmal SAH, rebleeding occurred before admission in 4 (3.3%) of the 11 patients with early rebleeding within 24 hours after the initial SAH. Inagawa et al 16 reported that in 418 patients with aneurysmal SAH admitted within 6 hours after the initial bleeding, rebleeding occurred before admission in 18 (4.3%) of the 61 patients with ultra-early rebleeding.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

Ohkuma

Tsurutani

Suzuki

2001

Stroke

301

182

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Background and Purpose-Rebleeding is a major cause of death and disability in aneurysmal subarachnoid hemorrhage (SAH); however, there has been no report focusing on rebleeding before hospitalization in neurosurgical or neurological institutions. The aim of this study was to clarify the incidence of prehospitalization rebleeding, its impact on the clinical course and prognosis in patients with aneurysmal SAH, and the possible factors inducing it. Methods-In 273 patients who were admitted to our institution within 24 hours after the initial SAH bleeding and whose clinical course before admission could be fully evaluated, the patients' clinical conditions and CT findings on admission, operability, prognosis, and possible factors inducing rebleeding were comparatively evaluated between the patients with and without an episode of prehospitalization rebleeding. Results-Of the 273 patients, 37 (13.6%) patients suffered from 39 episodes of rebleeding in the ambulance or at the referring hospital before admission to our hospital. The peak time of rebleeding was within 2 hours (77%), in which the incidence was statistically significant compared with that occurring 2 to 8 hours after the initial SAH bleeding (PϽ0.01).The group experiencing rebleeding showed more severe Hunt and Hess grades on admission, higher rates of intracerebral hematoma, of intraventricular hematoma, and of subdural hematoma on CT scan on admission, less operability, and poorer prognoses with statistically significant differences compared with the group that did not experience rebleeding. Systolic arterial pressure Ͼ160 mm Hg was a possible risk factor of rebleeding (odds ratio 3.1, 95% CI 1.5 to 6.8). Conclusions-Rebleeding during transfer and at the referring hospital is not rare. To improve overall outcome of aneurysmal SAH, the results obtained in this study should be made available to general practitioners and the doctors devoted to emergency medicine.

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Significance of “ultra-early” rebleeding in subarachnoid hemorrhage

Cited by 80 publications

References 47 publications

Does Treatment of Ruptured Intracranial Aneurysms Within 24 Hours Improve Clinical Outcome?

Does Treatment of Ruptured Intracranial Aneurysms Within 24 Hours Improve Clinical Outcome?

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Incidence and Significance of Early Aneurysmal Rebleeding Before Neurosurgical or Neurological Management

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