The long-term outcome in patients with multiple aneurysms. Incidence of late hemorrhage and implications for treatment of incidental aneurysms.

The proper treatment of multiple and incidental aneurysms remains controversial because the long-term result of different modes of management is unclear. This report evaluates the long-term outcome (follow-up period averaged 7.7 years) in 182 patients with multiple aneurysms who suffered a subarachnoid hemorrhage (SAH) to document the incidence of late bleeding. Of the 182 patients, 132 were treated by bed rest and 50 by surgery (craniotomy) directed at only the ruptured aneurysm. Seventy of the patients with bed rest were alive after 6 months. Twenty-one of these conservatively treated patients (30%) suffered a late hemorrhage, which is equal to the previously reported average yearly rebleed rate (3%) with a single aneurysm of the anterior circulation. There was no evidence that a previously intact aneurysm had ruptured in SAH patients treated with bed rest, indicating that late hemorrhage was due to rerupture from the original aneurysm. Patients who were hypertensive and who had a large aneurysm had an increased risk of late rehemorrhage. A linear discriminant analysis was developed to predict late rebleeding. The fate of intact aneurysms was evaluated by following patients with multiple aneurysms treated by craniotomy directed only at the ruptured aneurysm. Of the 50 craniotomy patients, 38 were alive after 6 months. In this group, the minimal risk of rupture of an intact aneurysm is approximately 1% per year. The presence of hypertension increased the risk of late hemorrhage. In conclusion, patients with multiple untreated aneurysms managed by bed rest have a late rehemorrhage rate equal to that observed in patients with a single cerebral aneurysm; the data indicate that rupture of intact aneurysms is not insignificant.

Multiple intracranial aneurysms: identifying the ruptured lesion.

The problems associated with the identification of the source of bleeding in multiple intracranial aneurysms are discussed, and the contribution towards diagnosis of each method of examination and investigation are evaluated, special emphasis is laid on the use of CAT scanning and electroencephalography as additional aids in localisation.

Spontaneous intracranial bleeding in hemorrhagic diathesis.

Eight patients with spontaneous intracranial bleeding secondary to hemophilia A, afibrinogenemia, and thrombocytopenia are described. The clinical picture was that of increased intracranial pressure of gradual onset with variable signs and symptoms. Both the hemostatic defect and the intracranial bleeding were proved by laboratory investigations and CT scanning. Mortality was 75% (six of eight patients). The two remaining patients recovered completely following combined medical and surgical treatment, and are alive and well.

Spontaneous intracranial hemorrhage secondary to von Willebrand's disease.

Four cases of spontaneous intracranial hemorrhage secondary to von Willebrand's disease are presented. The hemostatic management of the disease is discussed. A policy for screening of patients afflicted with intracranial hemorrhage secondary to von Willebrand's disease is proposed.

Factor VIII R:Ag as a prognostic parameter in intracranial haemorrhage.

Factor VIII R:Ag was measured serially in 42 patients who had intracranial haemorrhage. It was found that the factor decreased or remained static in the 24 patients who improved (p less than 0.025), while it increased in the 18 who died (p less than 0.0005). It is suggested that this factor can be used as a prognostic parameter to predict the outcome after intracranial haemorrhage.