Rebleeding is a major problem following aneurysmal SAH. In the first 28 days (in untreated patients), approximately 30% of patients would rebleed; of these 70% die. In the following few months the risk gradually falls off but it never drops below 3.5% per year.
Percentage chance of rebleeding per year, in the subsequent decade
Days since first bleed Years since first bleed
Adapted from Winn, Richardson, Jane 1977 Annals of Neurology
If, for example, a patient survives the first 30 days after a bleed, there is still a 20% chance of a rebleed occurring in the next 5 months. Even if patients survive the 'high risk' period in the first 6 months, there is still a considerable chance of rebleeding and death in the subsequent years.
The clinical picture of rebleeding is that of SAH, but usually the effects are more severe than the initial bleed. Most patients lose consciousness; the risk of death from a rebleed is more than twice that from the initial bleed.
All patients deteriorating suddenly require a CT scan. This helps in establishing the diagnosis of rebleeding and excludes a remediable cause of the deterioration, e.g. acute hydrocephalus.
Percentage chance of rebleeding within first
6 months of the ictus
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