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Circumstances surrounding aneurysmal subarachnoid hemorrhage
W I Schievink1, J M Karemaker, L M Hageman
1Department of Neurosurgery and Physiology Laboratory, University of Amsterdam, The Netherlands.
Surgical Neurology
|October 1, 1989
Summary
Aneurysmal subarachnoid hemorrhage is often triggered by stressful events, particularly in men and for aneurysms not located in the internal carotid artery. Understanding these triggers is key to preventing rupture.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Neurology
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological condition.
- Identifying precipitating factors for aSAH is crucial for patient management and prevention strategies.
Purpose of the Study:
- To investigate the circumstances and activities preceding aneurysmal subarachnoid hemorrhage in a large patient cohort.
- To determine if specific demographic factors or aneurysm locations are associated with rupture during different types of events.
Main Methods:
- Retrospective analysis of 500 consecutive patients admitted with aneurysmal subarachnoid hemorrhage.
- Categorization of preceding events into stressful activities, non-strenuous activities, rest/sleep, or unknown.
- Statistical comparison of rupture circumstances between genders and aneurysm locations.
Main Results:
- Subarachnoid hemorrhage occurred during stressful events in 42.8% of patients, non-strenuous activities in 34.4%, and rest/sleep in 11.8%.
- Men (54.1%) were significantly more likely than women (36.6%) to experience hemorrhage during stressful events (p < 0.00025).
- Aneurysms at locations other than the internal carotid artery (48.1%) were more frequently associated with rupture during stressful events compared to internal carotid artery aneurysms (30.1%) (p < 0.005).
Conclusions:
- Stressful events are a common precipitant of aneurysmal subarachnoid hemorrhage.
- Gender and aneurysm location are significant factors influencing the likelihood of rupture during stressful events.
- Physiological mechanisms involving increased blood pressure and altered cerebrospinal fluid pressure likely contribute to aneurysmal rupture during specific activities.