Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature

G.R. Menon, S. Nair, R.M. Rao, M. Abraham, H.V. Easwer, K. Krishnakumar

Research output: Contribution to journalArticle

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Abstract

Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH) since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14%. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days), the mean admission to rebleed was 1.42 days (Range: 0-4) and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while one person rebled while defecating. Nine patients were taken up for emergency exploration immediately after rebleeding. From these, six patients died and three survived, but were severely disabled. The remaining eleven patients who were conservatively treated expired after varying periods of intensive care. Conclusions: Our incidence of rebleeding (2.14%) is considerably less than most of the other reported series, probably related to the delayed referral pattern. Probable predisposing factors for rebleed include old age, female sex and an anterior communicating artery location. Known risk factors such as hypertension, poor neurological grade on admission, stressful activity and aneurysm morphology do not appear to be significant in our study. Outcome is extremely poor following the rebleeds, either in immediate surgery or conservative treatment.
Original languageEnglish
Pages (from-to)247-251
Number of pages5
JournalAnnals of Indian Academy of Neurology
Volume10
Issue number4
DOIs
Publication statusPublished - 2007

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Aneurysm
Subarachnoid Hemorrhage
Angiography
Bleeding Time
Unconsciousness
Incidence
Spasm
Critical Care
Causality
Developing Countries
Observational Studies
India
Sleep
Emergencies
Referral and Consultation
Arteries
History
Hypertension
Mortality
Therapeutics

Cite this

Menon, G.R. ; Nair, S. ; Rao, R.M. ; Abraham, M. ; Easwer, H.V. ; Krishnakumar, K. / Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature. In: Annals of Indian Academy of Neurology. 2007 ; Vol. 10, No. 4. pp. 247-251.
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abstract = "Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH) since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14{\%}. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days), the mean admission to rebleed was 1.42 days (Range: 0-4) and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while one person rebled while defecating. Nine patients were taken up for emergency exploration immediately after rebleeding. From these, six patients died and three survived, but were severely disabled. The remaining eleven patients who were conservatively treated expired after varying periods of intensive care. Conclusions: Our incidence of rebleeding (2.14{\%}) is considerably less than most of the other reported series, probably related to the delayed referral pattern. Probable predisposing factors for rebleed include old age, female sex and an anterior communicating artery location. Known risk factors such as hypertension, poor neurological grade on admission, stressful activity and aneurysm morphology do not appear to be significant in our study. Outcome is extremely poor following the rebleeds, either in immediate surgery or conservative treatment.",
author = "G.R. Menon and S. Nair and R.M. Rao and M. Abraham and H.V. Easwer and K. Krishnakumar",
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Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature. / Menon, G.R.; Nair, S.; Rao, R.M.; Abraham, M.; Easwer, H.V.; Krishnakumar, K.

In: Annals of Indian Academy of Neurology, Vol. 10, No. 4, 2007, p. 247-251.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Patterns and predictors of in-hospital aneurysmal rebleed: An institutional experience and review of literature

AU - Menon, G.R.

AU - Nair, S.

AU - Rao, R.M.

AU - Abraham, M.

AU - Easwer, H.V.

AU - Krishnakumar, K.

N1 - cited By 1

PY - 2007

Y1 - 2007

N2 - Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH) since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14%. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days), the mean admission to rebleed was 1.42 days (Range: 0-4) and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while one person rebled while defecating. Nine patients were taken up for emergency exploration immediately after rebleeding. From these, six patients died and three survived, but were severely disabled. The remaining eleven patients who were conservatively treated expired after varying periods of intensive care. Conclusions: Our incidence of rebleeding (2.14%) is considerably less than most of the other reported series, probably related to the delayed referral pattern. Probable predisposing factors for rebleed include old age, female sex and an anterior communicating artery location. Known risk factors such as hypertension, poor neurological grade on admission, stressful activity and aneurysm morphology do not appear to be significant in our study. Outcome is extremely poor following the rebleeds, either in immediate surgery or conservative treatment.

AB - Background: Rebleeding is an important cause for mortality following aneurysmal subarachnoid hemorrhage. Early intervention is believed to reduce the risk of rebleeding. However, in developing countries such as India, early intervention is often difficult due to various reasons. The knowledge about the risks and predictors for rebleeding is essential to prioritize the management policy. Aims: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, to study the clinical profile of patients with rebleed and to review the controversial aspects on aneurysmal rebleed. Materials and Methods: This observational study is based on the retrospective analysis of the case records of all patients admitted with aneurysmal subarachnoid hemorrhage (SAH) since January 1999 in our institute. Twenty patients rebled after admission before surgical clipping, and these patients formed our study group. The findings were compared with all the major series on rebleeding published in literature. Results: Since January 1999, 952 patients underwent treatment for aneurysmal subarachnoid hemorrhage in our institute. Twenty patients rebled while awaiting surgery following the admission with an incidence of 2.14%. The study group included nine males and eleven females. The age of the patients ranged from 31 to 69 years, but the majority were in the sixth decade. Mean bleed to admission days was 7.9 days (range: 1-27 days), the mean admission to rebleed was 1.42 days (Range: 0-4) and the mean first bleed to rebleed was 9.26 days. The history of loss of consciousness at the time of bleeding was observed in 16 patients. Four patients bled before an angiogram could be performed. Two patients had giant aneurysms, while the rest had small aneurysms; two patients had multiple aneurysms. Angiographic spasm was observed in eight patients. In three patients, rebleeding was precipitated by angiogram. Twelve patients rebled while taking rest or in sleep, while one person rebled while defecating. Nine patients were taken up for emergency exploration immediately after rebleeding. From these, six patients died and three survived, but were severely disabled. The remaining eleven patients who were conservatively treated expired after varying periods of intensive care. Conclusions: Our incidence of rebleeding (2.14%) is considerably less than most of the other reported series, probably related to the delayed referral pattern. Probable predisposing factors for rebleed include old age, female sex and an anterior communicating artery location. Known risk factors such as hypertension, poor neurological grade on admission, stressful activity and aneurysm morphology do not appear to be significant in our study. Outcome is extremely poor following the rebleeds, either in immediate surgery or conservative treatment.

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JO - Annals of Indian Academy of Neurology

JF - Annals of Indian Academy of Neurology

SN - 0972-2327

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ER -