Risk of Rebleed in Perimesencephalic SAH

[Surfer34]

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

[Tina]

Thanks for the info surfer34 all seems very positive to me. Well done on the research !

[Surfer34]

Sorry, I forgot to include that this data is NOT for all "angiogram negative" SAH, but rather ONLY those that were identified as perimesencephalic.

Also, the data excludes rebleeds that occured in a 12 hour - 72 hour time period after initial bleed.

[Scottish Lass]

That is greatly encouraging! It is terrifying researching it on the web. One of the very saddening things is how difficult it can be to find positive information so I really hope these links get bumped up the Google listings!

[Sandi K]

Just pulling this thread forward so it's easier for the new members to find it. This one shows the links to the studies on NASAH's.

Thanks Surfer!

Sandi K.

[Surfer34]

hey sandi, you were diagnosied with perimesencephalic SAH right ? did you have a repeat cerebral angiogram ?

[Sandi K]

Yes, I had a perimesencephalic SAH and I have all my reports now so will reply to the other thread asking for details once my visitors have gone home tomorrow. I had one cerebral angiogram and 2 CT scans. The first CT scan was an hour after arriving at hospital and the second was three weeks later. Will follow with details tomorrow afternoon. I'm also finally (FINALLY) seeing a neurologist tomorrow morning. I've only seen a neurosurgeon so far and I didn't know there was a difference.

Sandi K.

[goldfish.girl]

Hi Surfer,

When I saw this thread I was scared to read it as expected to read something uncomfortable (denial is a great place for me!!).

This seems to be good news. I'm not sure though if this is about non anuerysm bleeds or both - however, I'm going to convince myself it's both (because that makes me feel better!).

Thank you for sharing the information.

Michelle