뇌지주막하출혈 후 재출혈

Abstract

Based on the review of literatures, this article discussed the frequency and timing of rebleeding after initial subarachnoid hemorrhage (SAH), and the risk factors and preventive strategy for rebleeding. In view of the active policy of early aneurysm surgery, the peak interval for rebleeding was the first 24 hours after the aneurysmal SAH. Patients with poor grades, ventricular drainage, angiography within 6 hours post-SAH, time interval between the last attack and admission, and reduced platelet function were proposed as a risk factor of rebleeding. Rebleeding from giant aneurysms occurred at a rate comparable to that associated with smaller aneurysm. The efficacy of short-term antifibrinolytic drugs was expected to minimize ultraearly rebleeding. When ventriculostomy is necessary, intracranial pressure should be maintained between 15 and 25 mmHg to minimize transmural pressure gradients. Securing ruptured aneurysm on an emergency basis remained open to debate.