Risk of rupture of a second aneurysm in patients with multiple aneurysms.

TLDR: Treatment of the symptomatic lesion is commonly considered adequate in patients with multiple aneurysms and in four instances the second hemorrhage was fatal, as shown by autopsy.

Abstract: HERE are different opinions about the mortality associated with multiple aneurysms. MeKissock, et al., 2 state that multiple aneurysms are associated with a higher natural mortality than single aneurysms. In the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage, 3 the multiple aneurysm patients had the same prognosis for survival as those with single aneurysms. According to McKissock, recurrent hemorrhage virtually always occurs from the original lesion. Nishioka 3 found little evidence to suggest that more than one aneurysm would rupture within the followup time in the Cooperative Study. Therefore, treatment of the symptomatic lesion is commonly considered adequate. At the Neurosurgical Clinic of the University Central Hospital during the years 1957-1968, we have operated on 84 patients with multiple aneurysms in whom the ruptured aneurysm was identified with certainty at the operation. Ten of these patients had a recurrent hemorrhage during followup periods varying from 4 months to 11 years. In eight of these 10 patients the recurrent hemorrhage was shown to be due to rupture of another previously unruptured aneurysm, in four instances the second hemorrhage was fatal. In one of the remaining patients the second hemorrhage did occur from the original lesion, as shown by autopsy. In the other case, autopsy was not performed, and it is not known which of the aneurysms bled. Case Reports