Incidence Of Subarachnoid Hemorrhage Research Articles

Prospective Outpatient Follow-Up of Early Cognitive Impairment in Patients with Mild Traumatic Brain Injury and Intracranial Hemorrhage.

Mild traumatic brain injury (mTBI) encompasses a spectrum of disability including early cognitive impairment (ECI). The Brain Injury Guidelines (BIG) suggest mTBI patients can be safely discharged from the Emergency Department. Although half of mTBI patients with intracranial hemorrhage (ICH) have evidence of ECI, it is unclear what percentage of these patients' ECI persists after discharge. We hypothesize a significant proportion of trauma patients with mTBI and ECI at presentation have persistent ECI at 30-day follow-up. A single-center prospective cohort study including adult trauma patients with ICH or skull fracture plus a Glasgow coma scale (GCS) of 13-15 on arrival was performed. Participants were screened for ECI using the Rancho Los Amigos Scale (RLA), and ECI was defined as a RLA < 8. We compared ECI and non-ECI groups for demographics, injury profile, computed tomography (CT) imaging (e.g., Rotterdam CT score) and outcomes with bivariate analysis. 30-day follow up phone calls were performed to re-evaluate RLA for persistent ECI and concussion symptoms. From 62 patients with ICH or skull fracture and mTBI, 21 (33.9%) had ECI. Patients with ECI had a higher incidence of subarachnoid hemorrhage (85.7% versus 46.3%, p=0.003) and higher Rotterdam CT score (p=0.004) compared to those without ECI. On 30-day follow up, 6 of 21 patients (26.6%) had persistent ECI. In addition, 7 (33.3%) patients had continued concussion symptoms. Over one-third of mTBI patients with ICH had ECI. At 30-day post-discharge follow-up over one-fourth of these patients had persistent ECI and 33% had concussion symptoms. This highlights the importance of identifying ECI prior to discharge as a significant portion may have ongoing difficulties reintegrating into work and society.

Subarachnoid Haemorrhage Incidence Pattern Analysis with Circular Statistics.

Knowledge about biological rhythms of diseases may not only help in understanding the pathophysiology of diseases but can also help health service policy makers and emergency department directors to allocate resources efficiently. Aneurysmal subarachnoid haemorrhage (SAH) has high rates of morbidity and mortality. The incidence of SAH has been attributed to patient-related factors such as characteristics of aneurysms, smoking, and hypertension. There are studies showing that the incidence of aneurysmal SAH appears to behave in periodic fashions over long time periods. However, there are inconsistencies in the literature regarding the impact of chronobiological factors such as circadian, seasonal, and lunar cycle factors on the occurrence of SAH. In this study, we focused on the analysis of a temporal pattern of SAH (infradian rhythms) with a novel approach using circular statistical methods. We aimed to see whether there is a circular pattern for the occurrence of SAH at all and if so, whether it can be related to known temporal patterns based on available literature. Our study did not support the notion that aneurysmal subarachnoid haemorrhages occur on any specific day in a cycle with specific lengths up to 365 days including specific weekdays, full moon, equinoxes, and solstices. Hence, we found no relationship between SAH incidence and timing. Study in larger populations using similar circular statistical methods is suggested.

Angioarchitecture Classification and Treatment Modalities of Craniocervical Junction Arteriovenous Fistulas: A Cohort Study of 155 Patients

BACKGROUND AND OBJECTIVES: Craniocervical junction (CCJ) arteriovenous fistulas (AVFs) are rare. Variability in clinical manifestations and treatment strategies for CCJ AVFs stems from differences in their angioarchitecture. Our study aims to categorize CCJ AVFs based on their angioarchitecture and explore the associated clinical features and treatment modalities for distinct CCJ AVF types. METHODS: The authors conducted a retrospective analysis of patients with CCJ AVFs treated at a single neurosurgical facility over the past decade. These patients were classified based on the angioarchitecture of their CCJ AVFs. The analysis included an evaluation of angioarchitecture, clinical characteristics, treatment strategies, and outcomes. RESULTS: The study included 155 patients, with a median age of 56 years, collectively manifesting 165 CCJ AVFs. Our classification identified 4 distinct CCJ AVF types: epidural AVFs (19 [11.5%]), dural AVFs (98 [59.4%]), radicular AVFs (33 [20.0%]), and perimedullary AVFs (15 [9.1%]). Further differentiation was applied based on the presence of pial feeders. The predominant fistula location was at cervical-1 (77.0%). Ascending intradural drainage (52.7%) and descending intradural drainage (52.1%) were frequently observed drainage patterns. Patients with dural AVF predominantly presented with venous hypertensive myelopathy, whereas patients with other types of CCJ AVFs showed a higher incidence of subarachnoid hemorrhage (P = .012). Microsurgery was the predominant treatment, applied in the management of 126 (76.4%) AVFs, whereas 8 (4.8%) AVFs exclusively underwent interventional embolization and 25 (15.2%) received a combination of interventional embolization and microsurgical treatment. CONCLUSION: CCJ AVFs can be distinguished based on the fistula location and the arterial feeders. Currently, microsurgery stands as the preferred treatment strategy for CCJ AVFs, whereas interventional embolization plays a distinctive role in cases with specific angioarchitecture or as a pretreatment measure before microsurgery.

Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021

Subarachnoid hemorrhage is typically diagnosed by noncontrast head computed tomography (CT); lumbar puncture is recommended if computed tomography is nondiagnostic, although CT cerebral angiography has been promoted as an alternative to lumbar puncture in this diagnostic pathway. The outcomes of this debate in practice have not been studied. To determine whether CT cerebral angiography use has increased in lieu of lumbar puncture among emergency department (ED) patients with headache, with an increase in unruptured intracranial aneurysm detection. This retrospective cohort study took place in 21 community EDs of an integrated health care system in Northern California between 2015 and 2021. Participants were adult (aged >17 years) health plan members with a chief concern of headache. Exclusions were prior diagnoses of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral arteriovenous malformation, or cerebrospinal fluid shunt. Data were analyzed from October to November 2023. CT cerebral angiography and/or lumbar puncture during the ED encounter. Primary and secondary outcomes were 14-day and 90-day unruptured intracranial aneurysm detection, respectively. Safety outcomes were missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. The annual incidence of unruptured intracranial aneurysm detection was normalized to the incidence of subarachnoid hemorrhage (UIA:SAH ratio). Average annualized percentage changes were quantified using joinpoint regression analysis. Among 198 109 included ED encounters, the mean (SD) age was 47.5 (18.4) years; 140 001 patients (70.7%) were female; 29 035 (14.7%) were Black or African American, 59 896 (30.2%) were Hispanic or Latino, and 75 602 (38.2%) were White. Per year, CT cerebral angiography use increased (18.8%; 95% CI, 17.7% to 20.3%) and lumbar punctures decreased (-11.1%; 95% CI, -12.0% to -10.4%), with a corresponding increase in the 14-day UIA:SAH ratio (3.5%; 95% CI, 0.9% to 7.4%). Overall, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of UIA. Results were similar at 90 days and robust to sensitivity analyses. Subarachnoid hemorrhage (1004 cases) and bacterial meningitis (118 cases) were misdiagnosed in 5% and 18% of cases, respectively, with no annual trends (P = .34; z1003 = .95 and P = .74; z117 = -.34, respectively). In this cohort study of ED patients with headache, increases in CT cerebral angiography use were associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. While this shift in diagnostic strategy appeared safe in the short-term, the long-term consequences remain unclear.

Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019

Stroke is a leading cause of death and disability in the US. Accurate and updated measures of stroke burden are needed to guide public health policies. To present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and describe trends from 1990 to 2019 by age, sex, and geographic location. An in-depth cross-sectional analysis of the 2019 Global Burden of Disease study was conducted. The setting included the time period of 1990 to 2019 in the US. The study encompassed estimates for various types of strokes, including all strokes, ischemic strokes, intracerebral hemorrhages (ICHs), and subarachnoid hemorrhages (SAHs). The 2019 Global Burden of Disease results were released on October 20, 2020. In this study, no particular exposure was specifically targeted. The primary focus of this analysis centered on both overall and age-standardized estimates, stroke incidence, prevalence, mortality, and DALYs per 100 000 individuals. In 2019, the US recorded 7.09 million prevalent strokes (4.07 million women [57.4%]; 3.02 million men [42.6%]), with 5.87 million being ischemic strokes (82.7%). Prevalence also included 0.66 million ICHs and 0.85 million SAHs. Although the absolute numbers of stroke cases, mortality, and DALYs surged from 1990 to 2019, the age-standardized rates either declined or remained steady. Notably, hemorrhagic strokes manifested a substantial increase, especially in mortality, compared with ischemic strokes (incidence of ischemic stroke increased by 13% [95% uncertainty interval (UI), 14.2%-11.9%]; incidence of ICH increased by 39.8% [95% UI, 38.9%-39.7%]; incidence of SAH increased by 50.9% [95% UI, 49.2%-52.6%]). The downturn in stroke mortality plateaued in the recent decade. There was a discernible heterogeneity in stroke burden trends, with older adults (50-74 years) experiencing a decrease in incidence in coastal areas (decreases up to 3.9% in Vermont), in contrast to an uptick observed in younger demographics (15-49 years) in the South and Midwest US (with increases up to 8.4% in Minnesota). In this cross-sectional study, the declining age-standardized stroke rates over the past 3 decades suggest progress in managing stroke-related outcomes. However, the increasing absolute burden of stroke, coupled with a notable rise in hemorrhagic stroke, suggests an evolving and substantial public health challenge in the US. Moreover, the significant disparities in stroke burden trends across different age groups and geographic locations underscore the necessity for region- and demography-specific interventions and policies to effectively mitigate the multifaceted and escalating burden of stroke in the country.

Abstract TP1: Changing Trends in the Epidemiology of Subarachnoid Hemorrhage: A Population-Based Study

Background: There are conflicting data on temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes. We examined trends from 1993-2020 in a long-running population-based stroke study conducted in the Greater Cincinnati Northern Kentucky (GCNK) region. Methods: Using a well-validated approach, we ascertained all incident nontraumatic SAHs among residents of the GCNK region in the following study periods; July 1993-June 94, calendar years 1999, 2005, 2010, 2015, and 2020. Potential cases were identified by ICD codes, abstracted, and then adjudicated by physicians. Aneurysmal SAH (aSAH) was defined as those with culprit aneurysms; cases with no available vessel imaging were considered aSAH if the hemorrhage volume was “massive” or if the patient died rapidly after onset. Incidence rates were compared over time using linear regression after normalizing to 2010 census demographics. The primary outcome assessed was unadjusted 30-day Case Fatality Rate (CFR), which was available through 2015. Results: We identified 518 SAH cases, of which 372 were aSAH (71.8%). Overall SAH incidence rate was stable over time, ranging from 8-10 cases per 100,000 person-years (Figure Panel A); however, the rate of aSAH showed a statistically significant decline, going from 7.2 cases/100,000 person-years in 1993 to 5.2 cases/100,000 person-years in 2020 (trend P =0.02). There was a nonsignificant increase in nonaneurysmal SAH ( P =0.09 for trend). Overall 30-day CFR declined significantly through 2015 ( P =0.006, Figure Panel B), driven predominantly by a decline in aSAH CFR (from 39.3% to 23.7%, trend P =0.04). Conclusion: We observed a significant decline in the incidence of aSAH from 1993-2020; however, overall SAH incidence was stable in the setting of numerically more nonaneurysmal SAHs. Further study is needed to understand the causes of this trend. 30-Day CFR has significantly improved both for overall SAH and for aSAH.

Abstract TMP73: Incidence and Outcomes for Aneurysmal Subarachnoid Hemorrhage During Pregnancy: A 20-year Analysis of the National Inpatient Sample From 2000-2019

Introduction: Pregnancy is a risk factor for subarachnoid hemorrhage (SAH). Albeit rare, it can be a devastating condition with high rates of mortality and morbidity. We aim to better understand this risk and its impact on in-hospital outcomes over a longitudinal time period in a large population based sample. Methods: We analyzed the 2000-2019 National Inpatient Sample, selecting for aneurysmal SAH (aSAH). Pregnant patients were identified. Demographics, comorbidities, and outcomes were compared between pregnant and not pregnant groups. We used T-tests and chi-squared tests , and created a 1:1 propensity score matched cohort. Variables with notable differences (&gt;0.1 standardized mean) were used for multivariable regression, determining adjusted odds ratios (AOR) and beta coefficients for the impact of pregnancy on outcomes. Results: Of the 662,981 SAH patients identified, 0.82% were pregnant. SAH incidence in these patients increased over our study period. Pregnant patients were more often African American (34.9% vs 15.2%) and were more likely to have Medicaid insurance (43.4% vs 12.5%). They had a lower Elixhauser Comorbidity Score (6.01 vs 8.52). They had less hydrocephalus (8.7% vs 23.0), coma (5.4% vs 11.5%), and ventilator use (16.3% vs 28.4%). However, they experienced seizures more often (18.1% vs 12.3). Their rate of in-hospital mortality was lower (7.3% vs 24.2%), and they were more frequently discharged to home or short term hospitals (72.9% vs 38.8%). After propensity matching, pregnant patients had a reduced risk of in-hospital mortality (AOR 0.47, p&lt;0.001). They were also more likely to be discharged home or to short term hospital although these were not statistically significant to our pre-specified alpha. Conclusion: sSAH in pregnancy appears to be very rare and is associated with better outcome compared to the general population, as the majority of pregnant patients with aSAH present with favorable neurological status.

Risk of Cerebral Aneurysm Rupture After Liver Transplantation: Development and Validation of a Hemorrhagic Stroke Scoring Model.

Liver transplantation (LT) patients appear to be more prone to neurological events compared to individuals undergoing other types of solid-organ transplantation. The aims of the present study were to analyze the prevalence of unruptured intracranial aneurysms (UIAs) in patients undergoing liver transplantation (LT) and to examine the perioperative occurrence of subarachnoid hemorrhage (SAH). Also, it intended to systematically identify the risk factors of SAH and hemorrhagic stroke (HS) within a year after LT and to develop a scoring system which involves distinct clinical features of LT patients. Patients who underwent LT from January 2012 to March 2022 were analyzed. All included patients underwent neurovascular imaging within 6 months before LT. We conducted an analysis of prevalence and radiological features of UIA and SAH. The clinical factors that may have an impact on HS within one year of LT were also reviewed. Total of 3,487 patients were enrolled in our study after applying inclusion and exclusion criteria. The prevalence of UIA was 5.4%. The incidence of SAH and HS within one year following LT was 0.5% and 1.6%, respectively. We developed a scoring system based on multivariable analysis to predict the HS within 1-year after LT. The variables were a poor admission mental status, the diagnosis of UIA, serum ammonia levels, and Model for End-stage Liver Disease (MELD) scores. Our model showed good discrimination among the development (C index, 0.727; 95% confidence interval [CI], 0.635-0.820) and validation (C index, 0.719; 95% CI, 0.598-0.801) cohorts. The incidence of UIA and SAH was very low in LT patients. A poor admission mental status, diagnosis of UIA, serum ammonia levels, and MELD scores were significantly associated with the risk of HS within one year after LT. Our scoring system showed a good discrimination to predict the HS in LT patients.

Alcohol Consumption and Helmet Use in Patients with Traumatic Brain Injury due to Motorcycle Accident

AbstractAlcohol consumption is an important risk factor for traumatic brain injury (TBI), and it has a great impact on its incidence and severity. However, studies suggest potential beneficial effects of alcohol during hospitalization and in the prognosis of moderate or severe TBI, with conflicting results. The objective of the present study was to associate alcohol consumption and helmet use in TBI patients, as well as the prognostic variables and patterns of injuries secondary to TBI. We analyzed 109 medical records of patients who suffered TBI due to a motorcycle accident. We evaluated data on alcohol consumption, helmet use, TBI severity, and tomographic findings on admission. The subjects with moderate or severe TBI were evaluated regarding hospitalization, mortality and prognosis variables. Patients who wore a helmet at the time of trauma had lower rates of skull fracture and extradural hematoma (EDH), but an increased incidence of subarachnoid hemorrhage (SAH). Furthermore, patients with moderate or severe TBI who were those under alcohol intoxication had a greater need for Intensive Care Unit (ICU) admission and a tendency to have a lower in-hospital mortality rate and a higher score on the Glasgow Prognostic Score (GPS). Thus, although the consumption of alcohol has an impact on the incidence and severity of TBI at admission, it seems to be related to a lower in-hospital mortality rate and a better prognosis. In addition, helmet use is essential to prevent injuries from direct head-to-shield impact, but no similar reduction in the incidence of injuries caused by indirect forces was observed.

Microsurgical Treatment of Anterior Communicating Artery Aneurysms: An Analysis of 74 Consecutive Cases. Approach Side Choice and Outcome Considerations

Abstract Introduction Anterior communicating artery aneurysms (ACoAAs) are intracranial aneurysms whose treatment is still considered a challenging task. Materials and Methods Altogether, 74 patients were included in this study. The variables included age, sex, comorbidities, incidence of subarachnoid hemorrhage (SAH), the Fisher, Hunt-Hess, and WFNS scores, approach side, length of hospital stay, and mortality. We also investigate A1/A2 dimensions, association with approach side choice and the influence of surgeon's experience on the outcome. Results There were 61 patients (82.2%) admitted with SAH and 13 were treated for unruptured aneurysms. The A1 and A2 branches were larger ipsilaterally to the selected approach side (p &lt; 0,001). No deaths occurred in the unruptured aneurysm group. In the SAH group, mortality was strongly correlated with the Hunt-Hess score (p &lt; 0.001), Fisher grade (p &lt; 0.001), and WFNS score (p &lt; 0.001). No significant difference was found in mortality between the right-side and the left-side approaches (p = 0.253). A significant survival difference was identified on the group operated by the senior surgeon versus the non-senior group (p = 0.048). Discussion and Conclusion A1 dominance was identified as a factor associated to the approach side for SAH cases at our center. Understanding the factors involved in brain aneurysm surgery remains a relevant and underexplored subject. Further studies involving larger case series and multicenter collaborations are necessary to elucidate these factors and to determine the external validity of our findings.

An Analysis of the Incidence and Cost of Intracranial Aneurysm and Subarachnoid Haemorrhage Treatment between 2013 and 2021

The incidence of unruptured intracranial aneurysms (UIAs) amounts to 3.2% among adults. The annual risk of aneurysm rupture is 2-10% and it results in subarachnoid haemorrhage (SAH). The aim of this study is to assess changes in the incidence of unruptured intracranial aneurysms and subarachnoid haemorrhages in Poland between 2013 and 2021 and the cost associated with their in-hospital treatment in the acute phase. The analysis was based on the National Health Fund database. Patients diagnosed with UIA and SAH and hospitalised between 2013 and 2021 were chosen. The statistical analysis was performed with an assumed significance level of α = 0.05. The ratio between the prevalence of SAH and UIA diagnoses was 4:6. The proportion of women in relation to men was higher in both diagnoses. The highest proportions of patients with diagnoses SAH and UIA were found in highly urbanised provinces. The value of medical services in 2021 compared to 2013 increased by 81.8%. The highest values in this period were recorded in Mazowieckie province, and the lowest were recorded in Opolskie province. The overall number of patients hospitalised with diagnosis of UIA or SAH did not decrease, but the risk of aneurysm rupture probably decreased, which resulted in lower incidence of SAH in subsequent years of observation. The recorded changes in the dynamics of the value of medical services per patient or per hospitalisation largely coincided. However, it is difficult to speculate on expected value levels as not all provinces showed linear changes in the value of services provided.

Epidemiology of Subarachnoid Hemorrhage in Isolated Islands in Japan: A Population-based Study in the Miyako Islands.

The Miyako Islands (with a population of approximately 50,000) are located in southwestern Japan, with a subtropical oceanic climate. This isolated location permitted a retrospective population-based epidemiological study of subarachnoid hemorrhage. We retrospectively enrolled 110 consecutive patients from 2010 to 2019 using the subarachnoid hemorrhage database at Okinawa Miyako Hospital, which is the only local facility with neurosurgeons. We calculated the incidence of subarachnoid hemorrhage standardized to the entire Japanese population. The seasonal distribution of subarachnoid hemorrhage onset and patients' epidemiological characteristics were also investigated. The standardized annual incidence of subarachnoid hemorrhage was 21.4 per 100,000 population, as reported previously in Japan. The patients' mean age was 62.1 ± 15.4 years, and women constituted 60.9%. Anterior communicating artery aneurysms were most common. The endovascular treatment for ruptured aneurysms was increasing as standard levels in Japan. The rates of symptomatic vasospasm and secondary hydrocephalus requiring additional neurosurgical treatment were 2.7% and 19.1%, respectively. The mortality rate was 23.6%. The percentage of patients with a modified Rankin scale score of 0-2 at discharge was 55.5%. There were no differences in the frequency of subarachnoid hemorrhage associated with seasonal distribution or climatic factors. The incidence, baseline characteristics, and clinical outcomes of subarachnoid hemorrhage in the Miyako Islands were similar to those in other regions of Japan. There are preferable epidemiological backgrounds for further practical clinical research.

Age and Sex-Related Anatomical Variation in Vessel Diameters of Circle of Willis in Patients of Subarachnoid Haemorrhage Using Digital Subtraction Angiography: A Retrospective Descriptive study

Introduction: Subarachnoid Haemorrhage (SAH) is a distinct form of stroke characterised by bleeding in the subarachnoid space. The incidence of SAH is influenced by various factors, including age, gender, and geographic location. Aim: To evaluate age and sex-related anatomical variation in vessel diameters of the Circle of Willis (CoW) in patients with SAH in Eastern India. Materials and Methods: A retrospective descriptive analysis was conducted on patients with ruptured intracranial aneurysms who were admitted to the Institute of Neurosciences in Kolkata and diagnosed with SAH using brain computed tomography between January 2014 and September 2015. Digital Subtraction Angiography (DSA) was performed on 50 patients, aged 15 to 70 years. The vessel diameters of CoW components were measured using specialised software. Statistical analysis using the Mann-Whitney test was conducted to assess differences in vessel diameters based on age and sex. Results: The results showed that older patients (≤40 years) had larger vessel diameters compared to younger patients (&lt;40 years) in most segments of the CoW, indicating possible age- related atherosclerotic changes. Among female patients, the younger age group exhibited a significantly larger mean vessel diameter of 1.67 mm in the Anterior Cerebral Artery (ACA) (A1) segment of the left-side compared to the older age group with a mean vessel diameter of 1.32 mm in the same segment (p-value=0.045). In general, males had larger vessel diameters than females, except in specific segments. Conclusion: The knowledge gained from this research can contribute to improve the accuracy and effectiveness of interventions, such as endovascular coiling or surgical clipping, and ultimately optimising patient outcomes.

Marked Reduction of Cerebral Vasospasm with Intrathecal Urokinase Infusion Therapy after Endovascular Coil Embolization of the Aneurysmal Subarachnoid Hemorrhage: A Case Series.

Delayed cerebral vasospasms after subarachnoid hemorrhage (SAH) are a risk factor for poor prognosis after successful treatment of ruptured intracranial aneurysms. Different strategies to remove clots from the subarachnoid space and prevent vasospasms have different outcomes. Intrathecal urokinase infusion therapy combined with endovascular treatment (EVT) can reduce the incidence of symptomatic vasospasms. To analyze the relationship between symptomatic vasospasms and residual SAHs after urokinase infusion therapy, we retrospectively reviewed the records of 348 consecutive patients managed with EVT and intrathecal urokinase infusion therapy for aneurysmal SAH at our institution between 2010 and 2021. Among them, 163 patients met the study criteria and were classified into two groups according to the presence of residual SAH in the cisterns, Sylvian fissures, and frontal interhemispheric fissure. The incidence of symptomatic vasospasms and the clinical outcomes were assessed. In total, eight (5.0%) patients developed symptomatic vasospasms. Patients with symptomatic vasospasms had a significantly higher incidence of residual SAH in the Sylvian or frontal interhemispheric fissures than those without (P <.0001). No patient with SAHs resolved by urokinase infusion therapy developed symptomatic vasospasms. However, the two groups did not differ significantly in terms of modified Rankin scale scores at discharge. Treatment with intrathecal urokinase infusion after EVT for aneurysmal SAH can substantially reduce the risk of clinically evident vasospasms.

Incidence, subtypes, sex differences and trends of stroke in Taiwan.

Chinese populations have been reported higher incidence of all strokes and intracerebral hemorrhage. However, few large-scale studies have evaluated changes of stroke epidemiology in the 21st century. We explored the rates of incidence of all first-ever strokes, subtypes, and 1-month case fatality by using data from the Taiwan National Health Insurance Research Database since 2004. Also, we investigated sex differences in stroke. Time-trend analysis was performed for incidence and case fatality rates of all strokes and subtypes in both sexes. The age-adjusted incidence of all strokes per 100,000 person-years decreased by 16%, from 251 (95% confidence interval [CI] 249-253) in 2004 to 210 (95% CI 209-212) in 2011 (p<0.001); it was always higher in Chinese men than in women. Among pathological subtypes, the incidence of intracerebral hemorrhage markedly decreased by 26% over the years (p<0.001), while that of ischemic stroke slightly decreased by 8%. However, when stratified by sex, the incidence of ischemic stroke decreased significantly in only women, not in men (men: p = 0.399, women: p = 0.004). Regarding the incidence of subarachnoid hemorrhage, it remained unchanged. Furthermore, the rate of 1-month case fatality decreased significantly for all strokes in both sexes (p<0.001). In Taiwan, the incidence rate of first-ever stroke decreased in both Chinese men and women in the early 21st century. Men had a higher incidence rate than women. Furthermore, a marked decrease was noted in the incidence of intracerebral hemorrhage, while a slight decrease was noted in that of ischemic stroke; however, the decreased incidence of ischemic stroke was significant in only women.

Spontaneous Subarachnoid Haemorrhage After COVID-19 Vaccination; a Rare Case Report

Introduction: Cerebrovascular incidents are considered uncommon but important complications of vaccination against coronavirus disease-2019 (COVID-19). Subarachnoid hemorrhages (SAH) usually occur due to an underlying cerebral aneurysm. In this study, we have reported a subarachnoid hemorrhage incidence in a patient shortly after receiving the COVID-19 vaccine (ChAdOx1-AstraZeneca). Case Presentation: A 69-year-old male with no remarkable risk factors referred to the emergency room with complaints of headache, nausea, and vomiting. The patient had received his first dose of vaccine against COVID-19 four days before symptoms started. An aggravated headache, nausea, elevated blood pressure (180/100), and drowsiness occurred on the second day of admission. Imaging implied on acute hydrocephalus and increased intracranial pressure (ICP) caused by subarachnoid hemorrhage. The condition was treated by inserting an external ventricular drain (EVD). We found no underlying vascular abnormality in primary and follow-up cerebral angiographies. Conclusions: Reported cerebral haemorrhages caused by COVID-19 vaccination are mostly intra-parench. Our study observed a type of cerebrovascular event that has not been reported frequently. Vaccine-associated cerebrovascular events, however rarely, are critical. It is important to demonstrate possible risks and complications, as vaccination programs against COVID-19 have become an essential part of health care in most countries.

Trends in the Incidence of Spontaneous Subarachnoid Hemorrhages in the United States, 2007-2017.

To test the hypothesis that age-specific, sex-specific, and race-specific and ethnicity-specific incidence of nontraumatic subarachnoid hemorrhage (SAH) increased in the United States over the last decade. In this retrospective cohort study, validated International Classification of Diseases codes were used to identify all new cases of SAH (n = 39,475) in the State Inpatients Databases of New York and Florida (2007-2017). SAH counts were combined with Census data to calculate incidence. Joinpoint regression was used to compute the annual percentage change (APC) in incidence and to compare trends over time between demographic subgroups. Across the study period, the average annual age-standardized/sex-standardized incidence of SAH in cases per 100,000 population was 11.4, but incidence was significantly higher in women (13.1) compared with that in men (9.6), p < 0.001. Incidence also increased with age in both sexes (men aged 20-44 years: 3.6; men aged 65 years or older: 22.0). Age-standardized and sex-standardized incidence was greater in Black patients (15.4) compared with that in non-Hispanic White (NHW) patients (9.9) and other races and ethnicities, p < 0.001. On joinpoint regression, incidence increased over time (APC 0.7%, p < 0.001), but most of this increase occurred in men aged 45-64 years (APC 1.1%, p = 0.006), men aged 65 years or older (APC 2.3%, p < 0.001), and women aged 65 years or older (APC 0.7%, p = 0.009). Incidence in women aged 20-44 years declined (APC -0.7%, p = 0.017), while those in other age/sex groups remained unchanged over time. Incidence increased in Black patients (APC 1.8%, p = 0.014), whereas that in Asian, Hispanic, and NHW patients did not change significantly over time. Nontraumatic SAH incidence in the United States increased over the last decade predominantly in middle-aged men and elderly men and women. Incidence is disproportionately higher and increasing in Black patients, whereas that in other races and ethnicities did not change significantly over time.

Recent Declining Trend of Incidence Rate of Subarachnoid Hemorrhage in Shimane, Japan: The Japan Incidence of Subarachnoid Hemorrhage (JIS) Study.

The "Izumo Study" revealed the incidence rate of subarachnoid hemorrhage (SAH) in Izumo City, Shimane Prefecture, Japan, from 1980 to 1998. However, no study has been published regarding the incidence of SAH in Shimane Prefecture after 1998. Most studies reporting the incidence of SAH in Japan have been conducted before 2000, although a few have been reported after 2000. This study aimed to assess the estimated age-adjusted incidence rate (AAIR) of SAH in Shimane Prefecture after 1998, following the Izumo Study. A retrospective study was conducted to identify the estimated AAIR of SAH in Shimane Prefecture, using the age-adjusted SAH mortality rate for this population from 1999 to 2017 and assuming that the case-fatality rate of SAH decreased by 0.7% annually from 45% in 1999 to 32.4% in 2017. We used linear regression analysis for trend to the estimated AAIR of SAH. Sensitivity analyses were also conducted by various case-fatality rates of SAH using assuming case-fatality rate based on previous reports. The estimated AAIR of SAH in Shimane Prefecture declined from 33.6 (95% confidence interval [CI]: 29.7-37.9) per 100,000 person-years in 1999, by 26.5%, to 24.7 (95% CI: 21.4-28.5) in 2017 (p < 0.01, r = 0.58). Declining trend of incidence rate of SAH in Shimane Prefecture from 1999 to 2017 was confirmed in this study.

Subarachnoid Haemorrhage-Incidence of Hospitalization, Management and Case Fatality Rate-In the Silesian Province, Poland, in the Years 2009-2019.

Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the data on SAH in the Silesian Province, Poland. The study was based on the data obtained from the administrative databases of the only public health insurer in Poland (the National Health Fund, NHF) from 2009 to 2019. The SAH cases were selected based on primary diagnosis coded in ICD-10 as I60. The total number of SAH cases was 2014 (41.8% men, 58.2% women). The number of SAH hospitalizations decreased from 199 in 2009 to 166 cases in 2019; p < 0.05. The median age increased from 58 in 2009 to 62 years in 2019; p < 0.001. Endovascular treatment or clipping of the aneurysm was performed in 866 cases (43%). An increase in in-hospital mortality was observed from 31% in 2009 to 38% in 2019 (p = 0.013). Despite the number of stroke units increasing, in-hospital mortality in SAH patients is high, and the number of vascular interventions seems insufficient. Better organization for care of SAH patients is needed in Poland.

Non-aneurysmal subarachnoid hemorrhage: Is the deep venous system the hidden culprit?

The exact cause of bleeding in non-aneurysmal sub-arachnoid hemorrhage (SAH) is yet to be established. The present study intends to evaluate the morphological variants of deep cerebral venous drainage, especially basal veins of Rosenthal (BVR), and to correlate if such a venous anomaly is associated with increased incidence of non-aneurysmal SAH. A prospective analysis of all the patients of age more than 12years with spontaneous non-aneurysmal SAH and undergone 4-vessel DSA for the diagnosis of the source of bleeding was included in the study (n = 59). The anatomy of the basal venous distribution was evaluated and was divided into 3 different types, namely normal (Type A), normal variant (Type B), and primitive (Type C), based on DSA findings. The follow-up of these cases was noted. The three groups were compared with one another. The median age of presentation was 51years with slight male predominance (52%). Primitive venous drainage was associated with a poorer grade at presentation (p = 0.002), more severe bleed (p = 0.001), vasospasm (p = 0.045), and a poorer outcome at 6months (p = 0.019). Hydrocephalous and vasospasm were seen in patients with primitive venous drainage. On multivariate regression analysis for poorer outcome, it was observed that a worse grade at presentation, extensive bleed, primitive venous drainage are independent predictors of an adverse outcome. The presence of primitive venous drainage has a linear relationship with the development of non-aneurysmal SAH with multi-cisternal hemorrhage, worse grade at presentation, and unfavorable outcome.