Neurosurgical Review

, Volume 29, Issue 1, pp 21–25 | Cite as

High re-bleeding rate in young adults after subarachnoid haemorrhage from giant aneurysms

  • Ralf Dirk Rothoerl
  • Thomas Finkenzeller
  • Thomas Schubert
  • Chris Woertgen
  • Alexander Brawanski
Original Article


Low re-bleeding rates within the first 14 days of aneurysmal subarachnoid haemorrhage are reported in young patients. Furthermore, re-bleeding rate for giant aneurysms does not exceed 20% according to the literature. Our own clinical impression is that the re-bleeding rate seems to be much higher in giant aneurysms than reported, particularly in young patients. The aim of this study was to evaluate re-bleeding rate after subarachnoid haemorrhage following rupture of giant aneurysms in a younger population. We reviewed records of 23 patients who were treated in our institution for subarachnoid haemorrhage from giant aneurysms between 1994 and 2003. By definition, the aneurysms were larger than 25 mm in diameter. Five patients were younger than 40 years of age at the time of the aneurysmal subarachnoid haemorrhage. All younger patients (<40 years of age) showed re-bleeding after the first subarachnoid haemorrhage within the first 14 days of the initial event. In four patients (20%) older than 40 years at the time of the haemorrhage re-bleeding could be observed within the first 14 days of subarachnoid haemorrhage. We can confirm the re-bleeding rate of approximately 20% in patients suffering from subarachnoid haemorrhage (SAH) in the group of patients older than 40 years of age. However, younger patients seem to be at much higher risk of re-bleeding from giant aneurysms.


Re-bleeding rate SAH Giant aneurysm 


  1. 1.
    Hillman J, von Essen C, Leszniewski W, Johansson I (1988) Significant “ultra early” rebleeding in subarachnoid hemorrhage. J Neurosurg 68:901–907PubMedGoogle Scholar
  2. 2.
    Horikoshi T, Akiyama I, Yamagata Z, Nukui H (2002) Retrospective analysis of the prevalence of asymptomatic cerebral aneurysm in 4518 patients undergoing magnetic resonance angiography—when does cerebral aneurysm develop? Neurol Med Chir (Tokyo) 42:105–112CrossRefGoogle Scholar
  3. 3.
    Kassell NF, Torner JC (1983) Aneurysmal rebleeding: a preliminary report from the Cooperative aneurysm study. Neurosurgery 23:479–481Google Scholar
  4. 4.
    Khurana VG, Piepgras DG, Whisnant JP (1998) Ruptured giant intracranial aneurysms. Part 1. A study of rebleeding. J Neurosurgery 88:425–429Google Scholar
  5. 5.
    Lanzino G, Kassell NF, Gennanson TP, Kongable GL, Truskowski LL, Torner JC, Jane JA (1996) Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg 85:410–418PubMedGoogle Scholar
  6. 6.
    Locksley HB (1996) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Report of the Cooperative Study of intracranial aneurysms and subarachnoid hemorrhage. Section V, Part Il. Based on 6368 patients in the Cooperative Study. J Neurosurg 25:321–368Google Scholar
  7. 7.
    Naidech AM, Janjua N, Kreiter KT, Ostapkovich ND, Fitzsimmons BF, Parra A, Commichau C, Connolly ES, Mayer SA (2005) Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Arch Neurol 62:410–416CrossRefPubMedGoogle Scholar
  8. 8.
    Ogunbo B, Gregson B, Blackburn A, Barnes J, Vivar R, Sengupta R, Mendelow D (2003) Aneurysmal subarachnoid hemorrhage in young adults. J Neurosurg 98:43–49Google Scholar
  9. 9.
    Pare L, Delfino R, Leblanc R (1992) The relationship of ventricular drainage to aneurysmal rebleeding. J Neurosurg 76:422–427PubMedGoogle Scholar
  10. 10.
    Phillips LH II, Whisnant JP, O’Tallon WM, Sundt TM Jr (1980) The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 30:1034–1040PubMedGoogle Scholar
  11. 11.
    Rosenorn J, Eskesen V, Schmidt K (1987) The risk of rebleeding from ruptured intracranial aneurysm. J Neurosurg 67:329–332PubMedGoogle Scholar
  12. 12.
    Torner JC, Kassel NF, Wallace RB, Adams HP Jr (1981) Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study. Neurosurgery 9:506–513PubMedGoogle Scholar
  13. 13.
    Trumpy JH (1967) Subarachnoid hemorrhage. Time sequence of recurrences and their prognosis. Acta Neurol Scand 43:48–60PubMedGoogle Scholar
  14. 14.
    Weir B (1987) Aneurysms affecting the nervous system. Williams & Wilkins, Baltimore, pp 187–208Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ralf Dirk Rothoerl
    • 1
    • 4
  • Thomas Finkenzeller
    • 2
  • Thomas Schubert
    • 3
  • Chris Woertgen
    • 1
  • Alexander Brawanski
    • 1
  1. 1.Department of NeurosurgeryUniversity of RegensburgRegensburgGermany
  2. 2.Department of RadiologyUniversity of RegensburgRegensburgGermany
  3. 3.Department of PathologyUniversity of RegensburgRegensburgGermany
  4. 4.Klinik und Poliklinik für NeurochirurgieKlinikum der Universität RegensburgRegensburgGermany

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