title: Late recurrence of subarachnoid hemorrhage after treatment for ruptured aneurysms: patient characteristics and outcomes.
abstract: OBJECTIVE
  Patients with subarachnoid hemorrhage (SAH) who have been successfully treated for all detected aneurysms are at risk for recurrence of SAH. We assessed the characteristics, complications of re-treatment, and outcomes of patients with recurrent SAH as important factors in determining whether to screen patients for new aneurysms.
  
  
  METHODS
  We studied patients admitted between 1987 and 2002 to three hospitals in the Netherlands for recurrent SAH. Patients had received treatment previously for all aneurysms identified after initial SAH. We collected data for age, sex, risk factors, site, and number of the aneurysm(s), time between the first and the second SAH, complications of re-treatment, and outcome after recurrent SAH.
  
  
  RESULTS
  We identified 30 patients: 27 women and 3 men. Thirty-two aneurysms were documented; 19 were classified as de novo, 8 were classified as regrowth, and 5 had been missed in retrospect. The mean time between the first and the second SAH was 7.8 years (range, 0.25-17 yr for all aneurysms and 2.8-14 yr for de novo aneurysms). Nine patients (30%) had a family history of SAH. No specific complications were reported with reoperation in 21 patients. Ten patients (33%) died, 4 patients (14%) were severely disabled, and 16 patients (53%) had good outcomes.
  
  
  CONCLUSIONS
  Among patients admitted with recurrent SAH, there is a predominance of women and patients with familial SAH. Reoperation is not associated with specific complications. Outcome after recurrent SAH is similar to that after initial SAH.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. m.wermer@neuro.azu.nl
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.forename: Gabriël J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Paut
authors.initials: P
authors.lastname: Greebe
authors.forename: Kees W
authors.initials: KW
authors.lastname: Albrecht
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Dirven
authors.forename: Cees A
authors.initials: CA
authors.lastname: Tulleken
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D013997:Time Factors