An aneurysm or vascular malformation may rupture in a two phase pattern called the double rupture phenomenon.
Features of the double rupture:
(1) The arterial defect ruptures, usually associated with symptoms.
(2) Local hemorrhage tamponades the leak, causing symptoms to disappear or to seem less significant.
(3) Some time later the rupture expands with massive hemorrhage with resultant shock and collapse.
(4) The person may die if the problem is not recognized and emergency surgery performed.
The double-rupture phenomenon can be particularly important for malpractice in the Emergency Department.
