Hijdra A, Vermeulen M, van Gijn J, van Crevel H
J Neurosurg. 1987 Jul;67(1):29-33. doi: 10.3171/jns.1987.67.1.0029.
In a series of 176 prospectively studied patients who survived for at least 24 hours after aneurysmal subarachnoid hemorrhage, 39 had at least one computerized tomography (CT)-proven rebleed within 4 weeks after the first rupture. There were peaks in the incidence of rebleeding at the end of the 2nd and 3rd weeks. Sudden loss of consciousness occurred in 35 patients, preceded in one-third of them by headache. A sudden increase in headache was a symptom of rebleeding in only one patient. Loss of brain-stem reflexes was recorded in 13 patients, respiratory arrest in six, and both symptoms in eight patients. Apnea was temporary in 11 patients. Rebleeding occurred as gross intraventricular hemorrhage in 20 patients, as a space-occupying hematoma in four, as both types of hemorrhage in three, and as a purely subarachnoid hemorrhage in 12. The location of the rebleed could not be inferred from the clinical features. Rebleeding was fatal in 51% of cases (two of 12 patients with a purely subarachnoid hemorrhage, and 18 of the other 27 patients (p less than 0.005)). The risk of rebleeding could not be predicted from the patients' clinical condition on admission or from the amount of subarachnoid blood identified on the initial CT scan. The risk of further rebleeding was significantly increased in survivors of a first rebleed (47%: p less than 0.01). Only seven (18%) of the 39 patients with rebleeding had survived at 3 months after the initial hemorrhage.
在一组176例经前瞻性研究的动脉瘤性蛛网膜下腔出血患者中，这些患者在首次破裂后至少存活了24小时，其中39例在首次破裂后4周内至少有一次经计算机断层扫描（CT）证实的再出血。再出血发生率在第2周和第3周结束时出现高峰。35例患者发生了意识突然丧失，其中三分之一的患者在意识丧失之前有头痛症状。只有1例患者中突然加重的头痛是再出血的症状。13例患者记录到脑干反射消失，6例呼吸骤停，8例患者同时出现这两种症状。11例患者的呼吸暂停是暂时的。20例患者的再出血表现为脑室内大出血，4例为占位性血肿，3例为两种类型的出血，12例为单纯蛛网膜下腔出血。无法从临床特征推断再出血的部位。51%的病例中再出血是致命的（12例单纯蛛网膜下腔出血患者中有2例，其他27例患者中有18例（p<0.005））。无法根据患者入院时的临床状况或初始CT扫描上发现的蛛网膜下腔出血量来预测再出血的风险。首次再出血的幸存者中再次发生再出血的风险显著增加（47%：p<0.01）。在39例再出血患者中，只有7例（18%）在初次出血后3个月时存活。
