RESUMEN
To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.