title: Outcome and prognostic factors after delayed second subarachnoid haemorrhage.
abstract: Data of patients suffering from delayed second subarachnoid haemorrhage (SAH) after aneurysm treatment are still missing. Patients become clearly older than before. Thus, the risk suffering from a second delayed SAH rises. The aim of this study was to analyse clinical outcome and prognostic factors in patients after delayed second SAH.
  
  
  
  From 1999 to 2013, 18 of 1,493 patients (1.2%) suffered from a second SAH. Clinical and radiological characteristics were entered into a prospective conducted database. Outcome was assessed according to modified Rankin Scale 6 months after second SAH. P < 0.05 was considered statistically significant.
  
  
  
  Eighteen patients were admitted to our department with a second SAH. The second SAH occurred at a mean interval of 144 months after surgical treatment and 78 months after endovascular treatment (P < 0.05), with an overall mean interval of 125 months. The earliest event of second SAH was after 35 months. In 11 (61%) patients, a de novo aneurysm was detected; in one patient (6%), no cause of second SAH was detected. In six (33%) cases, re-rupture of the formerly secured aneurysm was found. Half of the rebleedings occurred from a basilar aneurysm, 33% from an aneurysm of anterior communicating artery and in one patient from a median cerebral artery aneurysm. At second SAH, 8 of 18 patients presented WFNS grade I-III at time of admission (44%). Overall, favourable outcome was achieved in seven patients (39%). Four patients died (22%), one of them before treatment. Favourable outcome seems to be associated with younger age. In our patients, 39% achieved a favourable outcome after second SAH.
  
  
  
  A delayed second SAH is a rare entity. After delayed second SAH, age seems to be a prognostic factor for patients' outcome and patients seem to have a worse prognosis. Nonetheless, up to 40% of patients can achieve a favourable outcome.
authors.affiliation: Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. Nina.Brawanski@kgu.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Brawanski
authors.affiliation: Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Platz
authors.affiliation: Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Bruder
authors.affiliation: Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Senft
authors.affiliation: Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.affiliation: Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.affiliation: Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Konczalla
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
keywords: Aneurysm; Late rebleeding; Outcome; Prognostic factors; Subarachnoid haemorrhage