RECURRENT ANEURYSMAL SUBARACHNOID HEMORRHAGE - BLEEDING PATTERN AND INCIDENCE OF POSTHEMORRHAGIC ISCHEMIC INFARCTION

This report is based on a consecutive series of 162 patients with aneu rysmal subarachnoid haemorrhage (SAH), including 22 patients (14%) wit h recurrent SAH, who were treated within 72 h after the most recent bl eed. Of the 22 patients with recurrent haemorrhage: 68% were in poor c linical condition (Hunt & Hess grade 4-5); 73% presented with intracer ebral haemorrhage (ICH); 41% developed delayed ischaemic infarctions f rom chronic arterial spasm; 14% made a good recovery, while 41% died. Of the 140 patients with a single bleed: 34% were in poor clinical con dition (Hunt & Hess grade 4-5); 33% presented with ICH; 22% developed delayed ischaemic infarctions; 53% made a good recovery, while 19% die d. Our results suggest that a high incidence of intracerebral haemorrh age in conjunction with a more severe course of chronic arterial spasm substantially contributes to the high morbidity and mortality associa ted with recurrent SAH. In poor grade patients not suitable for acute open surgery, endovascular treatment should receive consideration for the prevention of early rebleeding.