Rebleeding from ruptured intracranial aneurysms: epidemiology, associated factors, physiopathology, and treatment
Keywords:
Antifibrinolitic treatment, Intracerebral hematoma, Intracraneal aneurism, Subarachnoid hemorrhageAbstract
OBJECTIVE: To review the recent aspects about epidemiology, related factors, physiopathology and treatment in rebleeding associated with aneurismatic subarachnoid haemorrhage.
DEVELOPMENT: Rebleeding is the most important cause of morbidity and mortality in patients with aneurismatic subarachnoid haemorrhage. There are factors associated with increase of this complication in many studies: systolic hypertension (more than 160 mm Hg), poor clinical condition at symptoms onset, intracerebral hematoma, size of the aneurism and sentinel headache. The main physiopathology mechanisms related are transmural pressure, fibrinolysis and coagulation system disorders. The administration of antifibrinolitic treatment in the first three days of subaracnoidea haemorrhage had been show decrease of rebleeding rate, also associated with the early surgery (conventional or endovascular).
CONCLUSIONS: Some factors are related with rebleeding, but are not clear the causal effect of them. The early surgery and short antifibrinolitic therapy had been the most useful treatment to prevent aneurismatic rebleeding.
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