Seasonal Variation in the Incidence of Aneurysmal Subarachnoid Hemorrhage Associated with Age and Gender: 20-Year Results from the Yamaguchi Cerebral Aneurysm Registry

2013 ◽  
Vol 41 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Hideyuki Ishihara ◽  
Ichiro Kunitsugu ◽  
Sadahiro Nomura ◽  
Hiroyasu Koizumi ◽  
Hiroshi Yoneda ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Age And Gender ◽  
And Gender

Cigarette smoking as a cause of aneurysmal subarachnoid hemorrhage and risk for vasospasm: a report of the Cooperative Aneurysm Study

1998 ◽  
Vol 89 (3) ◽  
pp. 405-411 ◽  
Author(s):  
Bryce K. A. Weir ◽  
Gail L. Kongable ◽  
Neal F. Kassell ◽  
John R. Schultz ◽  
Laura L. Truskowski ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cigarette Smoking ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Significant Risk ◽  
The United States ◽  
Age And Gender ◽  
Content Type ◽  
Younger Age ◽  
And Gender ◽  
Fine Print

Object. Cigarette smoking is associated with aneurysmal subarachnoid hemorrhage (SAH) and subsequent vasospasm. The purpose of this study was to quantify this association. Methods. Nearly 3500 patients with SAH from North America and Europe have been enrolled in five different multicenter, controlled studies coordinated at the Neuroclinical Trials Center of the Virginia Neurological Institute at the University of Virginia. Among the prospective data gathered were whether the patient smoked at the time of their most recent SAH and the evolution of angiographic vasospasm. The rate of smoking in the patients enrolled in the studies was compared with the expected rate by using a chi-square statistic adjusted for age and gender, in the general population in the United States (U.S.) and Europe. In virtually all age and gender subgroups, and for the combined populations in the five clinical trials, patients with SAH reported current smoking rates 2.5 times higher than expected based on U.S. and European national surveys (p < 0.0001). Cigarette smoking was also associated with younger age at onset of SAH (5–10 years, p < 0.0001) and increased incidence of clinically confirmed vasospasm (p < 0.005). Conclusions. The findings of a significantly increased representation of current cigarette smokers in the study populations and significant association with younger age at the time of SAH and increased incidence of vasospasm concur with recent reports of smoking as a significant risk factor for ruptured aneurysms and subsequent vasospasm.

scholarly journals Cigarette smoking and outcomes after aneurysmal subarachnoid hemorrhage: a nationwide analysis

2017 ◽  
Vol 129 (2) ◽  
pp. 446-457 ◽  
Author(s):  
Hormuzdiyar H. Dasenbrock ◽  
Robert F. Rudy ◽  
Pui Man Rosalind Lai ◽  
Timothy R. Smith ◽  
Kai U. Frerichs ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Subarachnoid Hemorrhage ◽  
Cigarette Smoking ◽  
Cerebral Aneurysm ◽  
Scale Score ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Institutional Care ◽  
Care Facility ◽  
Severity Scale ◽  
The Impact

OBJECTIVEAlthough cigarette smoking is one of the strongest risk factors for cerebral aneurysm development and rupture, there are limited data evaluating the impact of smoking on outcomes after aneurysmal subarachnoid hemorrhage (SAH). Additionally, two recent studies suggested that nicotine replacement therapy was associated with improved neurological outcomes among smokers who had sustained an SAH compared with smokers who did not receive nicotine.METHODSPatients who underwent endovascular or microsurgical repair of a ruptured cerebral aneurysm were extracted from the Nationwide Inpatient Sample (NIS, 2009–2011) and stratified by cigarette smoking. Multivariable logistic regression analyzed in-hospital mortality, complications, tracheostomy or gastrostomy placement, and discharge to institutional care (a nursing or an extended care facility). Additionally, the composite NIS-SAH outcome measure (based on mortality, tracheostomy or gastrostomy, and discharge disposition) was evaluated, which has been shown to have excellent agreement with a modified Rankin Scale score greater than 3. Covariates included in regression constructs were patient age, sex, race/ethnicity, insurance status, socioeconomic status, comorbidities (including hypertension, drug and alcohol abuse), the NIS-SAH severity scale (previously validated against the Hunt and Hess grade), treatment modality used for aneurysm repair, and hospital characteristics. A sensitivity analysis was performed matching smokers to nonsmokers on age, sex, number of comorbidities, and NIS-SAH severity scale score.RESULTSAmong the 5784 admissions evaluated, 37.1% (n = 2148) had a diagnosis of tobacco use, of which 31.1% (n = 1800) were current and 6.0% (n = 348) prior tobacco users. Smokers were significantly younger (mean age 51.4 vs 56.2 years) and had more comorbidities compared with nonsmokers (p < 0.001). There were no significant differences in mortality, total complications, or neurological complications by smoking status. However, compared with nonsmokers, smokers had significantly decreased adjusted odds of tracheostomy or gastrostomy placement (11.9% vs 22.7%, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.51–0.78, p < 0.001), discharge to institutional care (OR 0.71, 95% CI 0.57–0.89, p = 0.002), and a poor outcome (OR 0.65, 95% CI 0.55–0.77, p < 0.001). Similar statistical associations were noted in the matched-pairs sensitivity analysis and in a subgroup of poor-grade patients (the upper quartile of the NIS-SAH severity scale).CONCLUSIONSIn this nationwide study, smokers experienced SAH at a younger age and had a greater number of comorbidities compared with nonsmokers, highlighting the negative ramifications of cigarette smoking among patients with cerebral aneurysms. However, smoking was also associated with paradoxical superior outcomes on some measures, and future research to confirm and further understand the basis of this relationship is needed.

Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage

2018 ◽  
Vol 128 (1) ◽  
pp. 86-93 ◽  
Author(s):  
Christoph J. Griessenauer ◽  
R. Shane Tubbs ◽  
Paul M. Foreman ◽  
Michelle H. Chua ◽  
Nilesh A. Vyas ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Genetic Polymorphisms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Renin Angiotensin System ◽  
The United States ◽  
Dominant Effect ◽  
Potential Implication ◽  
Angiotensin System ◽  
Renin Angiotensin

OBJECTIVERenin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin-Angiotensin System (CARAS) study prospectively evaluated common RAS polymorphisms and their relation to aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe CARAS study prospectively enrolled aSAH patients and controls at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin-converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5′ exonuclease (TaqMan) genotyping assays and restriction fragment length polymorphism analysis.RESULTSTwo hundred forty-eight patients were screened, and 149 aSAH patients and 50 controls were available for analysis. There was a recessive effect of the C allele of the angiotensinogen (AGT) C/T single-nucleotide polymorphism (SNP) (OR 1.94, 95% CI 0.912–4.12, p = 0.0853) and a dominant effect of the G allele of the angiotensin II receptor Type 2 (AT2) G/A SNP (OR 2.11, 95% CI 0.972–4.57, p = 0.0590) on aSAH that did not reach statistical significance after adjustment for potential confounders. The ACE level was significantly lower in aSAH patients with the II genotype (17.6 ± 8.0 U/L) as compared with the ID (22.5 ± 12.1 U/L) and DD genotypes (26.6 ± 14.2 U/L) (p = 0.0195).CONCLUSIONSThe AGT C/T and AT2 G/A polymorphisms were not significantly associated with aSAH after controlling for potential confounders. However, a strong trend was identified for a dominant effect of the G allele of the AT2 G/A SNP. Downregulation of the local RAS may contribute to the formation of cerebral aneurysms and subsequent presentation with aSAH. Further studies are required to elucidate the relevant pathophysiology and its potential implication in treatment of patients with aSAH.

P3708Prognostic significance of electrocardiographic changes after subarachnoid hemorrhage

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yuba ◽  
Y Kimura ◽  
T Mukaida ◽  
T Aoyama ◽  
H Hirano ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Glasgow Coma Scale ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Qt Prolongation ◽  
Autonomic Nerve ◽  
World Federation ◽  
Coma Scale ◽  
Traumatic Subarachnoid Hemorrhage

Abstract Background and purpose Many reports have examined electrocardiographic (ECG) changes after subarachnoid hemorrhage from long ago; however, there are few reports on the prognosis of patients who have an ECG abnormality. Therefore, in this study, the prognoses of patients with subarachnoid hemorrhage showing abnormal ECG findings were retrospectively analyzed. Methods Over 30 months from January 2014 to June 2016, 199 patients (mean age, 61.1±17.0 years; 46.7% male) admitted with a subarachnoid hemorrhage (SAH) were enrolled. To assess the mechanism underlying abnormal ECG in the SAH, predictor variables, such as demographics (age, sex, and body surface area), hemodynamics (heart rate and systolic blood pressure), blood biochemical results, neurological assessments (Glasgow Coma Scale), and computed tomography (CT) severity classification (World Federation of Neurosurgical Societies classification) were recorded. The subarachnoid hemorrhage was classified into either the cerebral aneurysm rupture group (N=132) or traumatic subarachnoid hemorrhage group (N=67) and analyzed. Results In the cerebral aneurysm rupture group, the QT prolongation was significantly increased compared with the traumatic subarachnoid hemorrhage group (424.8±87.7 ms vs. 400.5±95.8 ms, P<0.05). There was a correlation between consciousness level (Glasgow Coma Scale) on admission and QT prolongation, and significant QT prolongation was observed in critical patients (Pearson's correlation coefficient test P=0.04). ST changes correlated with CT classification severity (WFNS classification), and the most severe group (WFNS Grade 5) showed significant ST changes. On admission, the cerebral aneurysm rupture group and 97.0% in the traumatic subarachnoid hemorrhage group. Conclusions Significantly prolonged QT and ST changes are noted in patients with severe aneurysmal subarachnoid hemorrhage. The cause of the ECG abnormality in subarachnoid hemorrhage patients is not yet understood. A small number of experimental animal models have shown that electrocardiogram abnormalities associated with subarachnoid hemorrhage develop in the brain stem, and an autonomic nerve abnormality may also be involved. A D-dimer is positively correlated with both aneurysm trauma and traumatic subarachnoid hemorrhage and may be used for auxiliary diagnosis of a subarachnoid hemorrhage.

Endothelin polymorphisms as a risk factor for cerebral aneurysm rebleeding following aneurysmal subarachnoid hemorrhage

2017 ◽  
Vol 157 ◽  
pp. 65-69 ◽  
Author(s):  
Paul M. Foreman ◽  
Robert M. Starke ◽  
Philipp Hendrix ◽  
Mark R. Harrigan ◽  
Winfield S. Fisher ◽  
...  
Keyword(s):  
Risk Factor ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage

scholarly journals Relationship between Postmenopausal Estrogen Deficiency and Aneurysmal Subarachnoid Hemorrhage

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Sadaharu Tabuchi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Experimental Studies ◽  
Reproductive Factors ◽  
Estrogen Deficiency ◽  
Therapeutic Implications ◽  
Vascular Physiology ◽  
Postmenopausal Estrogen ◽  
Molecular Pathophysiology

Aneurysmal subarachnoid hemorrhage (SAH) is one of the most severe forms of stroke, which results from the rupture of a cerebral aneurysm. SAH is the only type of stroke with a female predominance, suggesting that reproductive factors may play a significant role in the etiology. Estrogen has important effects on vascular physiology and pathophysiology of cerebral aneurysm and SAH and, thus, potential therapeutic implications. There have been growing bodies of epidemiological and experimental studies which support the hypothesis of a significant relationship between estrogen deficiency and cerebral aneurysm formation with subsequent SAH. This hypothesis is the focus of this review as well as possible pathology-based therapeutics with regard to aspects of molecular pathophysiology, especially related to women’s health.

Impact of comorbidity, age, and gender on seasonal variation in hip fracture incidence. A NOREPOS study

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Siri M. Solbakken ◽  
Jeanette H. Magnus ◽  
Haakon E. Meyer ◽  
Nina Emaus ◽  
Grethe S. Tell ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Hip Fracture ◽  
Fracture Incidence ◽  
Age And Gender ◽  
Hip Fracture Incidence ◽  
And Gender

Multiple ruptured cerebral aneurysms in a child with Takayasu arteritis

2008 ◽  
Vol 1 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Suresh N. Magge ◽  
H. Isaac Chen ◽  
Michael F. Stiefel ◽  
Linda Ernst ◽  
Ann Marie Cahill ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Aneurysm ◽  
Takayasu Arteritis ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Rare Presentation ◽  
Anterior Communicating Artery Aneurysm ◽  
Clip Application

✓The authors report the case of an 18-month-old girl who presented with a ruptured anterior communicating artery aneurysm, and who was later diagnosed with Takayasu arteritis. Her initial aneurysm was successfully treated with clip application. However, over a 6-month period she had multiple ruptures from new and rapidly recurring aneurysms adjacent to the clips. These aneurysms were treated with repeated craniotomy and clip application and then with endovascular coil placement. Aneurysmal subarachnoid hemorrhage is a rare presentation of Takayasu arteritis. To the authors' knowledge, this is the youngest reported patient with Takayasu arteritis to present with a ruptured cerebral aneurysm.

Seasonal variation in the incidence of aneurysmal subarachnoid hemorrhage in hospital- and community-based studies

2002 ◽  
Vol 96 (3) ◽  
pp. 497-509 ◽  
Author(s):  
Tetsuji Inagawa
Keyword(s):  
Risk Factors ◽  
Seasonal Variation ◽  
Subarachnoid Hemorrhage ◽  
Seasonal Variations ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Community Based ◽  
Patient Age ◽  
Content Type ◽  
Patient Âgé ◽  
Fine Print

Object. The aim of this study was to examine seasonal variations in the onset of aneurysmal subarachnoid hemorrhage (SAH) in one hospital-based and one community-based patient series. Methods. The study population consisted of 941 patients with aneurysmal SAH who were admitted to Shimane Prefectural Central Hospital and 358 patients who were treated in Izumo City, Japan. When investigated as a whole, no significant seasonal variations were found in either population; however, in both series, statistically significant seasonal trends, with a peak in winter and a nadir in summer, were found among patients aged 59 years or younger (p < 0.05 for the hospital-based series and p < 0.005 for the community-based series), but not among those aged 60 years or older, regardless of sex. In the hospital-based series, seasonal variations were most apparent at certain times of day, with significant variations observed between 8:00 a.m. and 10:00 a.m. or 8:00 a.m. and noon (p < 0.001 and p < 0.005, respectively), regardless of patient age, and between 4:00 p.m. and 6:00 p.m. for patients aged 59 years or younger (p < 0.05). Consequently, seasonal variations were significant during daytime hours (between 8:00 a.m. and 8:00 p.m., p < 0.005) but not during the night (between 8:00 p.m. and 8:00 a.m.). Similar tendencies were found in the community-based series. Among patients aged 59 years or younger who had no risk factors for SAH, these seasonal variations were significant in both series. In patients with untreated hypertension, who were current smokers and daily alcohol drinkers, however, no significant patterns were observed in either series, even among younger patients. Conclusions. In both hospital- and community-based studies, aneurysmal SAH appears to undergo seasonal variation, with a peak in winter and a nadir in summer. This seasonal pattern may be derived mainly from the occurrence of SAH in the morning, but may also be modified by patient age and SAH risk factors, resulting in the masking of significant seasonal patterns when all patients are considered together.

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