scholarly journals Association of single and multiple aneurysms with tobacco abuse: an @neurIST risk analysis

2019 ◽  
Vol 47 (1) ◽  
pp. E9 ◽  
Author(s):  
Bawarjan Schatlo ◽  
Oliver P. Gautschi ◽  
Christoph M. Friedrich ◽  
Christian Ebeling ◽  
Max Jägersberg ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
General Population ◽  
Risk Analysis ◽  
Intracranial Aneurysms ◽  
Lifestyle Modification ◽  
Smoking Status ◽  
Reference Population ◽  
Multiple Aneurysms ◽  
Risk Of Rupture ◽  
Tobacco Abuse

OBJECTIVEAlthough several studies have suggested that the incidence of intracranial aneurysms (IAs) is higher in smokers, the higher prevalence of subarachnoid hemorrhage (SAH) in smokers remains uncertain. It is unclear whether smoking additionally contributes to the formation of multiple aneurysms and the risk of rupture. The aim of this study was to determine whether smoking is associated with IA formation, multiplicity, or rupture.METHODSPatients from the prospective multicenter @neurIST database (n = 1410; 985 females [69.9%]) were reviewed for the presence of SAH, multiple aneurysms, and smoking status. The prevalence of smokers in the population of patients diagnosed with at least one IA was compared with that of smokers in the general population.RESULTSThe proportion of smokers was higher in patients with IAs (56.2%) than in the reference population (51.4%; p < 0.001). A significant association of smoking with the presence of an IA was found throughout group comparisons (p = 0.01). The presence of multiple IAs was also significantly associated with smoking (p = 0.003). A trend was found between duration of smoking and the presence of multiple IAs (p = 0.057). However, the proportion of smokers among patients suffering SAH was similar to that of smokers among patients diagnosed with unruptured IAs (p = 0.48).CONCLUSIONSSmoking is strongly associated with IA formation. Once an IA is present, however, smoking does not appear to increase the risk of rupture compared with IAs in the nonsmoking population. The trend toward an association between duration of smoking and the presence of multiple IAs stresses the need for counseling patients with IAs regarding lifestyle modification.

Demographic and clinical predictors of multiple intracranial aneurysms in patients with subarachnoid hemorrhage

2018 ◽  
Vol 128 (4) ◽  
pp. 961-968 ◽  
Author(s):  
Michael M. McDowell ◽  
Yin Zhao ◽  
Christopher P. Kellner ◽  
Sunjay M. Barton ◽  
Eric Sussman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Smoking History ◽  
Relative Risk Ratio ◽  
Base Case ◽  
Black Race ◽  
Multiple Aneurysms ◽  
Female Sex

OBJECTIVEPathophysiological differences that underlie the development and subsequent growth of multiple aneurysms may exist. In this study, the authors assessed the factors associated with the occurrence of multiple aneurysms in patients presenting with aneurysmal subarachnoid hemorrhage (SAH).METHODSConsecutive patients presenting with aneurysmal SAH between 1996 and 2012 were prospectively enrolled in the Subarachnoid Hemorrhage Outcome Project. Patients harboring 1, 2, or 3 or more aneurysms were stratified into groups, and the clinical and radiological characteristics of each group were compared using multivariate logistic regression.RESULTSOf 1277 patients with ruptured intracranial aneurysms, 890 had 1 aneurysm, 267 had 2 aneurysms, and 120 had 3 or more aneurysms. On multinomial regression using the single-aneurysm cohort as base case, risk factors for patients presenting with 2 aneurysms were female sex (relative risk ratio [RRR] 1.80, p < 0.001), higher body mass index (BMI) (RRR 1.02, p = 0.003), more years of smoking (RRR = 1.01, p = 0.004), and black race (RRR 1.83, p = 0.001). The risk factors for patients presenting with 3 or more aneurysms were female sex (RRR 3.10, p < 0.001), higher BMI (RRR 1.03, p < 0.001), aneurysm in the posterior circulation (RRR 2.59, p < 0.001), and black race (RRR 2.15, p = 0.001). Female sex, longer smoking history, aneurysms in the posterior circulation, BMI, and black race were independently associated with the development of multiple aneurysms in our adjusted multivariate multinomial model.CONCLUSIONSSignificant demographic and clinical differences are found between patients presenting with single and multiple aneurysms in the setting of aneurysmal SAH. These predictors of multiple aneurysms likely reflect a predisposition toward inflammation and endothelial injury.

Postoperative quality of life of patients treated for asymptomatic unruptured intracranial aneurysms

2007 ◽  
Vol 107 (6) ◽  
pp. 1086-1091 ◽  
Author(s):  
Shigeo Yamashiro ◽  
Toru Nishi ◽  
Kazunari Koga ◽  
Tomoaki Goto ◽  
Daisuke Muta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intracranial Aneurysms ◽  
Short Form ◽  
Reference Population ◽  
Anxiety And Depression ◽  
Unruptured Intracranial Aneurysms ◽  
Number Of Patients ◽  
Sf 36 ◽  
Risk Of Rupture

Object The aim of this study was to assess the quality of life (QOL) of patients who underwent surgery for asymptomatic unruptured intracranial aneurysms (UIAs). Methods The authors assessed QOL in 149 patients who had undergone microsurgical clipping of asymptomatic UIAs. They surveyed these patients using universal methods such as the 36-Item Short Form Health Survey (SF-36) for health-related QOL and the Hospital Anxiety and Depression Scale for anxiety and depression assessments. Results The patients' mean scores for each of the eight domains of SF-36 were comparable to those of a Japanese reference population. Analysis of data from the average-QOL and low-QOL subgroups showed that the low-QOL group contained a higher number of patients with preexisting heart diseases and restricted activities of daily living. Operative procedures and complications did not affect QOL. Conclusions Because 86% of the patients who underwent surgery manifested a QOL similar to the reference population, the authors suggest that elective surgery for asymptomatic UIAs is a reasonable treatment, especially in patients who are troubled by the risk of rupture. Postoperative decreases in QOL are not invariably attributable to the operation or its associated complications, but may be correlated with other chronic disorders. To select the appropriate treatment for asymptomatic UIAs, neurosurgeons and patients need information on the expected postoperative QOL.

scholarly journals Coccidioidal meningitis with multiple aneurysms presenting with pseudo–subarachnoid hemorrhage: illustrative case

2021 ◽  
Vol 2 (15) ◽  
Author(s):  
Rohin Singh ◽  
Visish M. Srinivasan ◽  
Joshua S. Catapano ◽  
Joseph D. DiDomenico ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
External Ventricular Drain ◽  
Severe Case ◽  
Western United States ◽  
Illustrative Case ◽  
Basal Cistern ◽  
Aneurysmal Rupture ◽  
Multiple Aneurysms ◽  
Prompt Treatment

BACKGROUND Coccidioidomycosis is a primarily self-limiting fungal disease endemic to the western United States and South America. However, severe disseminated infection can occur. The authors report a severe case of coccidioidal meningitis that appeared to be a subarachnoid hemorrhage (SAH) on initial inspection. OBSERVATIONS A man in his early 40s was diagnosed with coccidioidal pneumonia after presenting with pulmonary symptoms. After meningeal spread characterized by declining mental status and hydrocephalus, coccidioidal meningitis was diagnosed. The uniquely difficult aspect of this case was the deceptive appearance of SAH due to the presence of multiple aneurysms and blood draining from the patient’s external ventricular drain. LESSONS Coccidioidal infection likely led to the formation of multiple intracranial aneurysms in this patient. Although few reports exist of coccidioidal meningitis progressing to aneurysm formation, patients should be closely monitored for this complication because outcomes are poor. The presence of basal cistern hyperdensities from a coccidioidal infection mimicking SAH makes interpreting imaging difficult. Surgical management of SAH can be considered safe and viable, especially when the index of suspicion is high, such as in the presence of multiple aneurysms. Even if it is unclear whether aneurysmal rupture has occurred, prompt treatment is advisable.

scholarly journals EXPRESS: Preventive screening for intracranial aneurysms

2021 ◽  
pp. 174749302110245
Author(s):  
Gabriel Rinkel ◽  
Ynte Ruigrok
Keyword(s):  
Subarachnoid Hemorrhage ◽  
High Risk ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Preventive Treatment ◽  
Preventive Screening ◽  
Advantages And Disadvantages ◽  
Poor Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture

Background: Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage, ASAH) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after ASAH, prevention of ASAH has the highest potential to prevent poor outcome from ASAH. Aim: In this review, we describe the groups at high risk of ASAH who may benefit from preventive screening for unruptured intracranial aneurysms (UIA) followed by preventive treatment of UIAs found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening. Summary of review: Modelling studies show that persons with two or more affected first-degree relatives with ASAH and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for UIAs. One modelling study also suggest that persons with only one affected first-degree relative with ASAH are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of ASAH of up to 7%, but the prevalence of UIAs in such persons, and thus the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening –such as risk of incidental findings, very small UIAs that require regular follow-up, preventive treatment with inherent risk of complications and anxiety- should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged. Conclusions: Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all ASAH patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of UIA become available, the groups of persons who may benefit from screening could increase considerably.

scholarly journals Outcome of Patients with Multiple Intracranial Aneurysms after Subarachnoid Hemorrhage and Future Risk of Rupture of Unruptured Aneurysm

2021 ◽  
Vol 10 (8) ◽  
pp. 1712
Author(s):  
Seppo Juvela
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Aneurysm Rupture ◽  
Severe Disability ◽  
Rank Test ◽  
Multiple Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Risk Of Rupture ◽  
Cumulative Rate

The purpose was to study the risk of rupture of unruptured intracranial aneurysms (UIAs) of patients with multiple intracranial aneurysms after subarachnoid hemorrhage (SAH), in a long-term follow-up study, from variables known at baseline. Future rupture risk was compared in relation to outcome after SAH. The series consists of 131 patients with 166 UIAs and 2854 person-years of follow-up between diagnosis of UIA and its rupture, death or the last follow-up contact. These were diagnosed before 1979, when UIAs were not treated in our country. Those patients with a moderate or severe disability after SAH, according to the Glasgow Outcome Scale, had lower rupture rates of UIA than those with a good recovery or minimal disability (4/37 or 11%, annual UIA rupture rate of 0.5% (95% confidence interval (CI) 0.1–1.3%) during 769 follow-up years vs. 27/94 or 29%, 1.3% (95% CI 0.9–1.9%) during 2085 years). Those with a moderate or severe disability differed from others by their older age. Those with a moderate or severe disability tended to have a decreased cumulative rate of aneurysm rupture (log rank test, p = 0.066) and lower relative risk of UIA rupture (hazard ratio 0.39, 95% CI 0.14–1.11, p = 0.077). Multivariable hazard ratios showed at least similar results, suggesting that confounding factors did not have a significant effect on the results. The results of this study without treatment selection of UIAs suggest that patients with a moderate or severe disability after SAH have a relatively low risk of rupture of UIAs. Their lower treatment indication may also be supported by their known higher treatment risks.

scholarly journals The Role of Long Non-Coding RNAs in Intracranial Aneurysms and Subarachnoid Hemorrhage

Life ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 155
Author(s):  
Ilgiz Gareev ◽  
Ozal Beylerli ◽  
Gjumrakch Aliev ◽  
Valentin Pavlov ◽  
Adel Izmailov ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Molecular Mechanisms ◽  
Regulation Of Gene Expression ◽  
Gene Expression And Regulation ◽  
Pathological Conditions ◽  
Risk Of Rupture ◽  
Traumatic Subarachnoid Hemorrhage ◽  
Non Coding Rnas

Intracranial aneurysms (IAs) represent the most complex and relevant problem of modern neurology and neurosurgery. They serve as one of the main causes of non-traumatic subarachnoid hemorrhage (SAH), causing up to 85% of all cases of intracranial hemorrhage, which is associated with frequent disability and high mortality among patients. Unfortunately, the molecular mechanisms of the development and rupture of IAs are still under study. Long non-coding RNAs (lncRNAs) are non-coding RNAs that typically have a length of more than 200 nucleotides. It is known that lncRNAs regulate many processes, such as transcription, translation, cell differentiation, regulation of gene expression, and regulation of the cell cycle. In recent years, a lot of evidence has established their role in human diseases from oncology to cardiovascular disease. Recent studies have shown that lncRNAs may be involved in the pathogenesis of IAs. The study of lncRNAs and its targets in various pathological conditions of a person is a rapidly developing field, and it is likely that the knowledge obtained from these studies regarding the pathogenesis of intracranial aneurysms will have the potential to use lncRNAs in therapy, as well as in the diagnosis and prediction of high aneurysms risk of rupture.

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