22. European Stroke Conference 802 © 2013 S. Karger AG, Basel Scientific Programme 861 Intracerebral/subarachnoid haemorrhage and venous diseases A study of patients with subarachnoid hemorrhage showing rebleeding during initial treat-ment at the emergency department Y. IMAO1 Hashima city hospital, Hashima, JAPAN1 Introduction Rebleeding in cases of subarachnoid hemorrhage (SAH) markedly worsens the prog-nosis. Therefore, patients suspected to have SAH need to be carefully examined and treated. Herein, we report cases in which rebleeding occurred during emergency treatment prior to a definitive diag-nosis of SAH by cranial CT. Subjects and Methods The study involved 211 consecutive patients diagnosed as having SAH at our hospital during the past 15 years. Among these patients, those who were suspected to have developed rebleeding between their visit to our hospital and a definitive di-agnosis of SAH by cranial CT were investigated. Patients with acute clinical deterioration, such as a sudden decrease in the consciousness level and respiratory arrest were judged to have had rebleed-ing. Results 1) In all, 18 patients were considered to have developed rebleeding during emergency treatment. 2) The reasons for the patients being transported to our hospital by emergency service were headache and vomiting in 5 patients, impaired consciousness after headache in 6 patients and sudden onset of impaired consciousness in 7 patients. 3) Systolic blood pressure greater than 160 mmHg just after transportation was observed in 12 patients, but none of the patients received an-tihypertensive treatment prior to undergoing the cranial CT. 4) The time from SAH to rebleeding was less than 3 hours in 14 patients. 5) Radical surgery was performed in 13 patients, however, the modified Rankin scale scores at the time of discharge were 0 to 2 in 5 patients, 4 to 6 in 13 patients. Conclusions As conventionally described, rebleeding is common in patients with SAH within sev-eral hours of the first bleed and is associated with a poor prognosis. In patients strongly suspected as having SAH based on information from the emergency service staff, it may be better to give priority to antihypertensive treatment, sedative treatment, pain relief, etc., than to a definitive diagnosis by cranial CT.
Karger_ESC London_2013
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