Recurrent aneurysmal subarachnoid haemorrhage: Bleeding pattern and incidence of posthaemorrhagic ischaemic infarction

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