Are Multiple Intracranial Aneurysms, More Than 5 At One Time, Almost Exclusively A Female Disease? A Clinical Series and Literature Review

Abstract

Background: A large series of intracranial aneurysm patients managed at a high volume Midwest center was analyzed to evaluate the relationship of gender and other factors to aneurysm multiplicity. Methods: Patients admitted from December 1999 through October 2008 with the diagnosis of intracranial aneurysm were evaluated. There were 872 patients with a total of 1,438 aneurysms who met inclusion criteria. An extensive literature search was conducted for comparison data. Statistical analysis using Pearson’s chi-square test was performed with SPSS 20.0. Results: Multiple intracranial aneurysms (MIAs) were present in 37% of patients. Women more often had multiple aneurysms than men (39.2%vs.31.8%, p=.04). No men presented with more than five aneurysms, while nine women (1.3%) had six or more. Women were 2.15 times more likely to have 3 or more aneurysms compared to men (95%CI= 1.31-3.52, p=0.002) Patients between ages 40-59 years more often had MIAs (59.8%) than those under 40 (4.8%) or over 60 (35.3%) (p=.002). Patients with multiple aneurysms more often had dyslipidemia (7.3%vs.3.9%, p=0.03), family history of aneurysms (17.2%vs.9.8%, p=0.001) and past history of aneurysms (8.2%vs.4.3%, p=0.02) than patients with a single aneurysm. Women with hypothyroidism more often had multiple aneurysms than women without hypothyroidism (1% vs. 4.9%, p = 0.02). Conclusion: Severe aneurysm multiplicity, defined in this study as more than five aneurysms, has not been described previously as almost exclusively a female disease. Nor, to our knowledge, does data exist that demonstrates a cohort of males with more than five intracranial aneurysms.