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Updated: Aug 17, 2026

Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Risk factors for subarachnoid hemorrhage
A I Qureshi1, M F Suri, A M Yahia
1Department of Neurosurgery, State University of New York, Buffalo, USA. aiqureshi@hotmail.com
Insights
Cigarette smoking significantly increases subarachnoid hemorrhage (SAH) risk. This heightened risk persists even after quitting, emphasizing the critical need for early smoking cessation to prevent SAH.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Cigarette smoking is a known risk factor for subarachnoid hemorrhage (SAH).
- The impact of smoking cessation on SAH risk requires further investigation.
Purpose of the Study:
- To investigate the association between smoking status and SAH risk.
- To identify other cerebrovascular risk factors contributing to SAH.
Main Methods:
- A case-control study involving 323 SAH patients and 969 matched controls.
- Multivariate logistic regression analysis was used to assess the independent association of smoking and risk factors with SAH.
- A subgroup analysis focused on aneurysmal SAH.
Main Results:
- Both current (OR, 5.2) and previous smoking (OR, 4.5) were significantly associated with SAH.
- Hypertension also showed a significant association with SAH (OR, 2.4).
- Risk factors for aneurysmal SAH were similar to overall SAH, with current smoking (OR, 5.4) and previous smoking (OR, 4.1) showing strong associations.
Conclusions:
- Hypertension and cigarette smoking are confirmed risk factors for SAH.
- The elevated SAH risk associated with smoking persists even after cessation.
- Early smoking abstinence is crucial for mitigating SAH risk.
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.
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