脳動脈瘤再破裂における関連因子の検討  [in Japanese] Study of the Related Factors for Cerebral Aneurysmal Rerupture  [in Japanese]

To assess the predictor of rerupture, we statistically studied the related factors for 121 subarachnoid hemorrhage (SAH) cases during a recent 5-year period. Rerupture was classified into severe and mild ones; severe is defined as patients whose Hunt & Kosnik grade worsened after rerup-ture; mild is defined as patients who experienced severe headache or vomiting due to rerupture without a worsening of Hunt & Kosnik grade. Twenty-eight rerupture cases (23%) comprised 15 severe and 13 mild ones. Two had rerupture (one was mild, and the another was severe) after admission in spite of their compliance with our protocol for the prevention of rerupture. In all the rerupture cases, there was no factor that significantly affected aneurysmal rerupture. However, its incidence increased in the cases of vertebrobasilar artery aneurysm, bleb, and multiple aneurysms. On the other hand, in severe rerupture cases, vertebrobasilar artery aneurysm and multiple aneurysms significantly affected aneurysmal rerupture (p - 0.049, 0.037, respectively) in comparison with the no-rerupture cases. Furthermore, when comparison was made between severe rerupture cases and mild ones, there was no factor that significantly affected aneurysmal severe rerupture. However, the incidence of severe rerupture was higher in the cases of verte-brobasilar aneurysm and multiple aneurysms, while the incidence of mild rerupture was the same in the cases of internal carotid artery aneurysm and bleb. Rerupture, especially severe ones, occurred mainly within 6 hours before hospitalization after the initial SAH. Glasgow outcome scales (GOS) of mild rerupture cases were almost similar to no-rerupture ones; however, severe rerupture cases showed significantly worse results than the others (p = 0.038). To improve the outcome of SAH, we should be especially careful and plan an adequate management even in the period before hospitalization.