Surfer34 Posted November 16, 2010 Share Posted November 16, 2010 (edited) UPDATED : The first confirmed case of a perimesencephalic non aneurysmal rebleed was recently reported. I cant get the full report but here is the abstract. http://www.ncbi.nlm.nih.gov/pubmed/21663410 Its a 62 yr old male who rebleed 5 months after his initial bleed. When I started doing the math I came up with these general numbers......In America and Europe the number of PNASAH per year is about 2,000 combined. That means since the entity was first defined 30 years ago there should be about 60,000 cases in america and europe. That would mean that out of 60,000 people with PNASAH that only one has been confirmed to have rebleed. Averaged over 30 years that comes out to a number so low I wont even do the math. PNASAH is a condition that previsouly has been documented to never have had a confirmed case of a rebleed. All neurosurgons know this. Therefore, if there had been a suspected or confirmed case of a rebleed prior to this than surely it would have been reported. I wish I could read the entire study to get al the details but they arent available unless you pay. Either way, the rebleed risk in PNASAH is pretty darn low compared to aneurysmal risk (1-3% per year) and diffuse pattern non aneurysmal bleeds (.1 - .5% per year) So I am guessing all of us who have experienced a subarachnoid hemorrhage and survived are natually concered about the chances and risk of a bleed re-occuring. My doctor said the chance was "very low" and and it sounds like many people on this board have been told similiar things from their doctors. However, I wanted to research the issue myself and find out the true statistics and evidence. Here is what I came up with. 4 studies with approximately 250 study patients and a average follow up time of 3-5 years have found NO cases of a rebleed. The largest study is by Rinkel et al and their study had 160 patients. http://stroke.ahajournals.org/cgi/content/full/38/4/1222 http://www.uptodate.com/patients/content/abstract.do?topicKey=%7EkbxUbGmB8WXqiwH&refNum=30 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1388255/ Mayo Clinic Study short version http://www.mayoclinicproceedings.com/content/73/8/745.short long version http://www.mayoclinicproceedings.com/content/73/8/745.full.pdf+html I was very very encouraged that 4 studies found no cases of rebleeds and were confident enough to conclude that there is NO risk of rebleeding. Then I came across a small study of 21 patients that reported a male subject experienced a rebleed 31 months after his first bleed. This was surprising to me but still put the risk/chance of a rebleed at under 1%. http://jnnp.bmj.com/content/69/1/127.abstract?cited-by=yes&legid=jnnp;69/1/127 Upon further research though I found that the authors of previous studies had reviewed the smaller study and found some issues with it, namely the reported cases of the rebleed. They challenged whether it really happended or could be proved. For those who are interested here is a good back and forth between the two study authors. Short version http://jnnp.bmj.com/content/70/3/419.2?cited-by=yes&legid=jnnp;70/3/419a Long version http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737243/pdf/v070p00419a.pdf In my opinion, after reading these exchanges I believe one can conclude that the authors who claimed to have a patient rebleed certainly did not prove such and it can be concluded that no study has ever found and confirmed a patient with a perimesencephalic bleed and rebleed or even an anuerysmal combination with perimesencepahlic. Edited August 12, 2011 by Surfer34 Quote Link to comment Share on other sites More sharing options...
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