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Late recurrence of subarachnoid hemorrhage and intracranial aneurysms

Robert J Singer, MD
Christopher S Ogilvy, MD
Guy Rordorf, MD
Section Editor
Jose Biller, MD, FACP, FAAN, FAHA
Deputy Editor
Janet L Wilterdink, MD


Aneurysmal subarachnoid hemorrhage (SAH) is often a devastating event. However, therapeutic advances have added to the armamentarium for treating this malignant process. As case-fatality rates decline, attention is increasingly turned to the management of long-term complications. One of these is the enduring risk of recurrent SAH, which can occur despite successful endovascular or surgical treatment of the ruptured aneurysm.

This topic discusses the risk of recurrent aneurysm formation and subarachnoid hemorrhage after a patient has been treated for an initial subarachnoid hemorrhage. Other topics address acute aspects of aneurysmal subarachnoid hemorrhage, as well as the management of patients with unruptured intracranial aneurysms, and aneurysm screening in other high risk populations. (See "Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage" and "Treatment of aneurysmal subarachnoid hemorrhage" and "Unruptured intracranial aneurysms" and "Screening for intracranial aneurysm".)


Cumulative 8 to 10 year incidences of late rebleeding (more than one year after initial SAH) vary from 0.1 to 3.2 percent [1-5]. The risk of SAH recurrence has been estimated to be 15 to 22 times higher than the expected rate of a first SAH in a healthy age, sex matched cohort [2,4].

Independent risk factors for recurrent SAH in one study were current smoking, younger age, and multiple aneurysms at the time of the initial SAH [2]. Hypertension was an additional important risk factor for aneurysm regrowth or de novo aneurysm formation in another retrospective study [6]. Cigarette smoking and hypertension are also established risk factors for both unruptured intracranial aneurysms and aneurysmal subarachnoid hemorrhage. (See "Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage" and "Unruptured intracranial aneurysms".)


Recurrent SAH may result from recurrence of the treated aneurysm, rupture of another pre-existing aneurysm in a patient with multiple aneurysms, and de novo aneurysm formation.

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Literature review current through: Nov 2017. | This topic last updated: Jul 31, 2013.
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