Characteristics of the acute phase of subarachnoid hemorrhage in patients with recurrent ruptures of multiple cerebral aneurysms

Background. Multiple cerebral aneurysms (MCA) are associated with an increased risk of complications, particularly ruptures. The risk of rupture depends on the size, location, and morphological characteristics of the aneurysm. Aneurysms in the posteriorcirculation of the brain and those larger than 5 mm carry a higher rupture risk. Patients with comorbidities, such as hypertension, have an elevated risk of repeated MCA ruptures. MCA can remain asymptomatic until rupture occurs, making timely diagnosis challenging. Purpose – the aim of this study was to identify the characteristics of the acute period of subarachnoid hemorrhage (SAH) in patients after recurrent MCA ruptures. Materials and Methods. A retrospective cross-sectional study included 89 patients in the acute period of SAH due to MCA rupture. They were divided into two groups based on the number of ruptures. Demographic indicators (age, gender), clinicalinstrumental factors (comorbidities, extent of hemorrhage, severity at admission, clinical manifestations), treatment characteristics, and outcomes were analyzed using descriptive statistics and linear regression. Results. In this study, patients in both groups were equally likely to have mild neurological deficits after treatment (β = 0.0424, p = 0.657). Patients in group 2 were more likely to have severe neurological deficits and require assistance compared to patients in group 1 (β = 0.0989, p = 0.279). The probability of a fatal outcome was significantly higher in group 2 (β = 0.3227, p = 0.001). Conclusions. The acute period of MCA rupture presents with nonspecific, mildly symptomatic clinical features, with headaches predominating over focal symptoms. Most patients do not experience impaired consciousness, making timely diagnosis more difficult. Recurrent MCA ruptures significantly worsen the course of SAH and treatment outcomes, increasing mortality and making comprehensive treatment impossible. Patients with a single MCA rupture require careful monitoring and immediate exclusion of MCA from circulation.