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December 12, 2000

Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage

December 12, 2000 issue
55 (11) 1656-1660

Abstract

Article abstract—
Objective: To assess the time course of secondary ischemia and first rebleeding and the relation between the timing of operation and the time course of secondary ischemia in a consecutive series of patients with aneurysmal subarachnoid hemorrhage (SAH).
Methods: Life table methods were used to assess the daily rates of ischemia and of rebleeding on day 0, day 1 to 3, day 4 to 10, day 11 to 14, and day 15 to 21. The authors compared the time course of secondary ischemia between patients operated within 4 days of SAH and those operated after 10 days.
Results: Of 346 patients included, 220 were operated, 131 within 4 days and 74 after 10 days. The rebleed rate was highest on the day of the initial hemorrhage, then diminished, and increased slightly again during the second week. The rate of secondary ischemia was highest on day 4, diminished after day 10, but peaked again from day 14 to 18 for patients who were operated later than 10 days after aneurysmal rupture. The peak rate of ischemia was much higher after early than after late operation. Although patients with early operation were in a better clinical condition on admission, with a relatively low risk of secondary ischemia, the overall rate of secondary ischemia was as high as in patients with delayed operation. From day 11 to 21 the rebleed rate was higher than the rate of secondary ischemia.
Conclusions: These results indicate that operation is a risk factor for ischemia, especially when performed early. If operation is postponed, it should be planned soon after day 10, because of the relatively high rebleed rate from day 11 to 21.

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Information & Authors

Information

Published In

Neurology®
Volume 55Number 11December 12, 2000
Pages: 1656-1660
PubMed: 11113219

Publication History

Received: February 18, 2000
Accepted: August 24, 2000
Published online: December 12, 2000
Published in print: December 12, 2000

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Authors

Affiliations & Disclosures

Eva H. Brilstra, MD
From the University Department of Neurology, Utrecht; and Julius Center for Patient Oriented Research (Dr. Algra), University of Utrecht, the Netherlands.
Gabriel J. E. Rinkel, MD
From the University Department of Neurology, Utrecht; and Julius Center for Patient Oriented Research (Dr. Algra), University of Utrecht, the Netherlands.
Ale Algra, MD
From the University Department of Neurology, Utrecht; and Julius Center for Patient Oriented Research (Dr. Algra), University of Utrecht, the Netherlands.
Jan van Gijn, MD, FRCP
From the University Department of Neurology, Utrecht; and Julius Center for Patient Oriented Research (Dr. Algra), University of Utrecht, the Netherlands.

Notes

Address correspondence and reprint requests to Dr. E.H. Brilstra, University Department of Neurology, P.O. Box 85500, 3508 GA Utrecht, the Netherlands; e-mail: [email protected]

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