Risk Factors For Aneurysmal Subarachnoid Hemorrhage Research Articles

Increased rupture risk in small intracranial aneurysms associated with methamphetamine use.

Aneurysmal subarachnoid hemorrhage (SAH) is the most common cause of nontraumatic SAH. Current guidelines generally recommend observation for unruptured intracranial aneurysms smaller than 7 mm, for those are considered at low risk for spontaneous rupture according to available scoring systems. We observed a tendency for SAH in small intracranial aneurysms in patients who are methamphetamine users. A retrospective, single center study to characterize the size and location of ruptured and unruptured intracranial aneurysms in methamphetamine users was performed. Clinical characteristics and patient data were collected via retrospective chart review of patients with intracranial aneurysms and a history of methamphetamine use with a specific focus on aneurysm size and location. A total of 62 patients were identified with at least one intracranial aneurysm and a history of methamphetamine use, yielding 73 intracranial aneurysms (n = 73). The mean largest diameter of unruptured aneurysms (n = 44) was 5.1 mm (median 4.5, SD 2.5 mm), smaller than for ruptured aneurysms (n = 29) with a mean diameter of 6.3 mm (median 5.5, SD 2.5 mm). Aneurysms measuring less than 7 mm presented with SAH in 36.5%. With regard to location, 28% (n = 42) of anterior circulation aneurysms less than 7 mm presented with rupture, in contrast to 70% (n = 10) of posterior circulation aneurysms which were found to be ruptured. Methamphetamine use may be considered a significant risk factor for aneurysmal SAH at a smaller aneurysm size than for other patients. These patients may benefit from a lower threshold for intervention and/or aggressive imaging and clinical follow-up.

Abstract TP171: Liver Cirrhosis is Associated With an Increased Risk of Aneurysmal Subarachnoid Hemorrhage

Introduction: Cirrhosis has been associated with non-traumatic subarachnoid hemorrhage (SAH). Additionally, cirrhosis appears to contribute to the development of pulmonary vascular abnormalities. We therefore sought to investigate whether cirrhosis is associated specifically with aneurysmal SAH. Methods: We performed a retrospective cohort study using 2009-2015 inpatient and outpatient claims data from a 5% sample of Medicare beneficiaries ≥66 years of age. Our exposure was cirrhosis as defined by a previously validated algorithm using inpatient and outpatient ICD-9- CM diagnosis codes. The outcome of aneurysmal SAH was identified using a validated approach requiring an inpatient ICD-9-CM diagnosis code for non-traumatic subarachnoid hemorrhage, without concomitant diagnosis codes for trauma or rehabilitation. Additionally, to further ensure we were identifying aneurysmal SAH, we required the presence of an ICD-9-CM procedure code reflecting endovascular or surgical treatment of a cerebral aneurysm during the same hospitalization. Patients were censored at the time of death or end of Medicare coverage or on September 30, 2015. We used survival statistics to calculate incidence rates and Cox proportional hazards models to evaluate the association between cirrhosis and aneurysmal SAH after adjustment for demographics, established SAH risk factors, and Charlson comorbidities. Results: We identified 10,658 (0.6%) patients with cirrhosis from among the 1,778,604 beneficiaries in our sample. The mean age of patients with cirrhosis was 73.2 (±6.5) years, and 48% were female. Over a mean of 4.7 (±2.1) years of follow-up, 4,272 patients were hospitalized with aneurysmal SAH. The annual incidence of aneurysmal SAH in patients with cirrhosis was 0.11% (95% confidence interval [CI], 0.08-0.17%) compared to 0.05% (95% CI, 0.05-0.05%) in patients without cirrhosis. After adjustment for demographics, risk factors, and comorbidities, cirrhosis was independently associated with an increased risk of aneurysmal SAH (hazard ratio, 2.3; 95% CI, 1.5-3.4). Conclusions: We found that cirrhosis was associated with aneurysmal SAH among Medicare beneficiaries. Liver cirrhosis may be an independent risk factor for aneurysmal SAH.

A1/A2 polymorphism of GpIIIa gene and a risk of aneurysmal subarachnoid haemorrhage

Platelet glycoproteins are involved in pathophysiology of cerebrovascular diseases. The aim of this study was to investigate the association between the GpIIIa gene A1/A2 polymorphism and a risk of aneurysmal subarachnoid haemorrhage (SAH) in a Polish population. In a case-control study we genotyped 288 Caucasian patients with aneurysmal SAH and 457 age-, gender- and race-matched controls. The GpIIIa A1/A2 polymorphism was genotyped with RFLP technique. No difference was found in the distribution of the polymorphism between the cases and controls (cases: A1A1—201 (69.8%), A1A2—83 (28.8%) and A2A2—4 (1.4%) vs. controls: A1A1—323 (70.7%); A1A2—128 (28.0%); A2A2—6 (1.3%), P > 0.05. In a multivariate analysis female gender (OR = 1.950; 95%CI: 1.308–2.907), hypertension (OR = 4.774; 95%CI: 3.048–7.478) and smoking (OR = 2.034; 95%CI: 1.366–3.030), but not GpIIIa A1/A2 polymorphism, were independent risk factors for aneurysmal SAH. The GpIIIa A1/A2 polymorphism is not a risk factor of aneurysmal SAH in a Polish population.

Aneurysmal Subarachnoid Hemorrhage in a Mexican Multicenter Registry of Cerebrovascular Disease: The RENAMEVASC Study

Information on risk factors and outcome of persons with aneurysmal subarachnoid hemorrhage (SAH) in Mexico is unknown. We sought to describe the clinical characteristics, risk factors, and outcome at discharge of Mexican patients with aneurysmal SAH. A first-step surveillance system was conducted on consecutive cases confirmed by 4-vessel angiography from November 2002 to October 2004 in 25 tertiary referral centers. Age- and sex-matched control subjects were randomly selected by a 1:1 factor, for multivariate analysis on risk factors. We studied 231 patients (66% women; mean age 52 years, range 16-90 years). In 92%, the aneurysms were in the anterior circulation, and 15% had more than two aneurysms. After multivariate analysis, hypertension (odds ratio 2.46, 95% confidence interval 1.59-3.81) and diabetes mellitus (odds ratio 0.34, 95% confidence interval 0.17-0.68) were directly and inversely associated with aneurysmal SAH, respectively. Median hospital stay was 23 days (range 2-98 days). Invasive treatment was performed in 159 (69%) patients: aneurysm clipping in 126 (79%), endovascular coiling in 29 (18%), and aneurysm wrapping in 4 (2%). The in-hospital mortality was 20% (mostly due to neurologic causes), and 25% of patients were discharged with a modified Rankin score of 4 or 5. Hypertension is the main risk factor for aneurysmal SAH in hospitalized patients from Mexico. The female:male ratio is 2:1. A relatively low in-hospital mortality and a high frequency of invasive interventions are observed. However, a high proportion of patients are discharged with important neurologic impairment.

Risk of Aneurysmal Subarachnoid Hemorrhage

From the studied variables in subarachnoid hemorrhage (SAH) risk, hypertension is probably the most controvertible one. The aim of this study was to determine whether confirmed hypertension, prospectively diagnosed with strict criteria, is an independent risk factor for aneurysmal SAH. A case-control study was conducted in 2 colombian cities between July 2004 and June 2005. There were 163 new cases of SAH (mean age 51 years; 107 were women) with 2 controls per case: 1 hospital and 1 community control. Hypertension was defined according to cardiovascular criteria, based on target organ damage. In addition to hypertension, other variables were studied: present smoking, recent alcohol consumption, alcohol dependency, coffee consumption, cocaine use, and body mass index. A multivariate logistic regression model was used to determine whether hypertension was an independent risk factor. Among the studied variables, including confirmed hypertension, only present smoking became an independent risk factor for SAH. Confirmed hypertension is not an independent risk factor for aneurysmal SAH.

α 1 -Antichymotrypsin Gene ( SERPINA3 ) A/T Polymorphism as a Risk Factor for Aneurysmal Subarachnoid Hemorrhage

The member 3 of clade A of serine proteinase inhibitors (SERPINA3), known previously as the alpha1-antichymotrypsin, is an acute phase protein, the levels of which increase in acute and chronic inflammation. The A/T polymorphism of the SERPINA3 gene influences expression of SERPINA3 protein. SERPINA3 can be related to aneurysmal subarachnoid hemorrhage (SAH) by influencing inflammation or by regulating cathepsin G activity. We studied the significance of SERPINA3 A/T polymorphism in patients with aneurysmal SAH compared with healthy controls. A total of 180 patients with aneurysmal SAH and 263 healthy controls were genotyped for the SERPINA3 A/T polymorphism. Aneurysmal SAH was diagnosed by cranial computed tomography or lumbar puncture and digital subtraction angiography. SERPINA3 polymorphism was detected by polymerase chain reaction amplification and restriction enzyme digestion. The SERPINA3 genotype distribution in patients with aneurysmal SAH (AA-29 16.1%; AT-108 60.0%; TT-43 23.9%) differed significantly from controls (AA-70 26.6%; AT-123 46.8%; TT-70 26.6%; P=0.009). A logistic regression model showed that the presence of genotype with T allele (AT+TT; odds ratio [OR], 2.01; 95% CI, 1.19 to 3.38; P=0.009) or AA genotype (OR, 0.49; 95% CI, 0.30 to 0.84; P=0.009) of the SERPINA3 influences the risk for aneurysmal SAH independently from smoking, excessive alcohol consumption, and hypertension. The A/T polymorphism of SERPINA3 gene is associated with the risk factor for aneurysmal SAH.

Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan

The annual incidence of aneurysmal subarachnoid hemorrhage (SAH) in Izumo City, Japan, appears to be the highest rate among those reported; therefore the author investigated the risk factors for SAH in patients in this city. A case-control study of 247 patients (108 men and 139 women with ages ranging from 28-96 years) with aneurysmal SAH was conducted in Izumo between 1980 and 1998. Hypertension, diabetes mellitus, heart disease, liver disease, cigarette smoking, alcohol consumption, and serum levels of total cholesterol, aspartate aminotransferase, alanine aminotransferase, and urea nitrogen were assessed as possible risk factors for SAH by using conditional logistic regression. After adjustment for other risk factors, results of multivariate analysis showed that hypertension was the most powerful risk factor, regardless of age and sex. The odds ratio for hypertension was higher in women than in men. The second greatest risk factors were cigarette smoking in those 59 years of age or younger and in men and hypercholesterolemia in those 60 years of age or older and in women. Among individuals 60 years of age or older and among women, diabetes mellitus and heart disease were inversely associated with the risk of SAH. When analyses were performed in 219 cases of confirmed ruptured cerebral aneurysm, very similar results were obtained. Among patients in Izumo, hypertension was the most notable risk factor for aneurysmal SAH, regardlessof age and sex, followed by cigarette smoking in younger men and hypercholesterolemia in older women. In older women, diabetes mellitus and heart disease decreased the risk of SAH.

II genotype of the angiotensin-converting enzyme gene increases the risk for subarachnoid hemorrhage from ruptured aneurysm.

Evidence exists in support of a role of genetic factors in susceptibility to aneurysmal subarachnoid hemorrhage (SAH) in humans. Meta-analysis of 2 previous studies showed that the I allele of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism was a weak, but significant, risk factor for aneurysmal SAH. Moreover, a recent study has shown that the local renin-angiotensin system (RAS) is involved in the development of intracranial aneurysm. The aim of this study was to investigate the association between ACE I/D polymorphism and a risk for aneurysmal SAH in a Polish population. Ninety patients with aneurysmal SAH (mean age: 48.9+/-14.0 years) and 128 healthy controls matched for age and sex were genotyped for the ACE I/D polymorphism. Aneurysmal SAH was diagnosed by cranial computed tomography and/or lumbar puncture and digital subtraction angiography. ACE gene polymorphism was detected by polymerase chain reaction amplification of the intron 16-specific I/D fragments, 490-bp and 190-bp, respectively. The ACE genotype distribution in patients with aneurysmal SAH (II, 52.2%; ID, 15.6%; DD, 32.2%) differed significantly from controls (II, 23.4%; ID, 50.8%; DD, 25.8%) (P<0.001). A logistic regression model showed that the II genotype of ACE gene was independent from female sex and smoking as a risk factor for aneurysmal SAH (OR, 4.57; 95% CI, 2.35 to 8.90). Here we report that II genotype of ACE gene is a risk factor for aneurysmal SAH.

Risk Factors for Subarachnoid Hemorrhage

OBJECTIVE Cigarette smoking has been demonstrated to increase the risk of subarachnoid hemorrhage (SAH). Whether cessation of smoking decreases this risk remains unclear. We performed a case-control study to examine the effect of smoking and other known risk factors for cerebrovascular disease on the risk of SAH. METHODS We reviewed the medical records of all patients with a diagnosis of SAH (n = 323) admitted to Johns Hopkins Hospital between January 1990 and June 1997. Controls matched for age, sex, and ethnicity (n = 969) were selected from a nationally representative sample of the Third National Health and Nutrition Examination Survey. We determined the independent association between smoking (current and previous) and various cerebrovascular risk factors and SAH by use of multivariate logistic regression analysis. A separate analysis was performed to determine associated risk factors for aneurysmal SAH. RESULTS Of 323 patients admitted with SAH (mean age, 52.7 ± 14 yr; 93 were men), 173 (54%) were hypertensive, 149 (46%) were currently smoking, and 125 (39%) were previous smokers. In the multivariate analysis, both previous smoking (odds ratio [OR], 4.5; 95% confidence interval [CI], 3.1–6.5) and current smoking (OR, 5.2; 95% CI, 3.6–7.5) were significantly associated with SAH. Hypertension was also significantly associated with SAH (OR, 2.4; 95% CI, 1.8–3.1). The risk factors for 290 patients with aneurysmal SAH were similar and included hypertension (OR, 2.4; 95% CI, 1.8–3.2), previous smoking (OR, 4.1; 95% CI, 2.7–6.0), and current smoking (OR, 5.4; 95% CI, 3.7–7.8). CONCLUSION Hypertension and cigarette smoking increase the risk for development of SAH, as found in previous studies. However, the increased risk persists even after cessation of cigarette smoking, which suggests the importance of early abstinence from smoking.

Prevalence of risk factors for aneurysmal subarachnoid haemorrhage: results of a Japanese multicentre case control study for stroke

The pathogenesis of subarachnoid haemorrhage (SAH) is still unclear. To evaluate the risk factors for aneurysmal SAH, we conducted a multicentre case control study. All aneurysms were detected by cerebral angiography and the patients with SAH other than ruptured aneurysms were excluded. Information on past medical histories and other possible risk factors for SAH were assessed by a structured questionnaire. Data on the total 127 pairs (59 male and 68 female) were analysed. In a univariate analysis, family history of SAH [odds ratio (OR) 9.45], systemic hypertension (OR 2.65), cigarette smoking (OR 2.54) and regular alcohol consumption (OR 1.92) were significant risk factors for aneurysmal SAH. Heavy alcohol consumption (>350 g ethanol/week) was significant (OR 3.22), whereas light consumption (=<350 g/week) did not to increase the risks (OR 0.95). Both light (<20 cigarettes/day, OR 2.44) and heavy smoking (>=20 cigarettes/day, OR 2.72) were associated with an increased risk of SAH. In a multivariate analysis, after adjustment for other risk factors, family history of SAH, cigarette smoking and hypertension remained significant.

Subarachnoid haemorrhage: epidemiology, risk factors, and treatment options.

The present review focuses on subarachnoid haemorrhage (SAH) secondary to the rupture of an intracranial aneurysm, a condition with a high case fatality rate. Additionally, many of the surviving patients are left with significant disabilities. Risk factors for aneurysmal SAH include both genetic and acquired conditions. The most common presenting symptom is sudden onset of severe headache. Since headache is very common in the general population, it is not unusual that SAH is misdiagnosed at its onset with often catastrophic consequences. Unlike other acute neurological disorders such as brain injury, in which patient outcome is closely related to the extent of the injury occurring at the time of the trauma, patients with aneurysmal SAH are at risk of subsequent deterioration from 'avoidable' complications such as rebleed, vasospasm, hydrocephalus, and several other non-neurological general medical complications. Thus, the critical care management of the patient with SAH is of utmost importance in order to maximise the chances of satisfactory recovery. Although surgical clipping of the ruptured aneurysm remains the gold standard therapy, with the continuing refinement of endovascular techniques, a new, 'less invasive' option is now available, especially for patients considered poor surgical candidates.