Citation Information :
Kumar M, Kaur S, Aggarwal A, Salunke P, Mittal M. Determinants of Ruptured Cerebral Aneurysm and the Presenting Symptoms among Patients with SAH Admitted at a Tertiary Care Center in North India. 2021; 14 (1):2-7.
Introduction: Aneurysmal subarachnoid hemorrhage (SAH) is a serious disease with high rates of mortality and morbidity. The current study is carried out to assess the risk factors and clinical profile of the patients with aneurysmal SAH presenting to a tertiary care center in India.
Materials and methods: A single-center cross-sectional study was carried out on 65 cerebral aneurysm patients with an aneurysmal SAH. The sociodemographic details, comorbidities, risk factors, and the presenting symptoms experienced by the patients at the time of rupture of aneurysm were recorded by using a pre-validated questionnaire.
Results: The age of the participants ranged between 41 and 55 years and the majority were female. Maximum had experienced severe headache followed by vomiting and neck stiffness before rupturing of the aneurysm. Age above 45 years followed by hypertension, female gender, and smoking were identified as major risk factors among the study subjects.
Conclusion: Advanced age, smoking, and female gender are found main risk factors with severe headache, vomiting, and neck rigidity as main symptoms. Risk factors and symptoms are important to know for future research and preparing treatment modules.
King JT, Horowitz MB, Kassam AB, Yonas H, Roberts MS. The short form-12 and the measurement of health status in patients with cerebral aneurysms: performance, validity, and reliability. J Neurosurg 2005(3):489–493. DOI: 10.3171/jns.2005.102.3.0489.
Jill Novitzke RN. The basics of brain aneurysms: a guide for patients. J Vasc Interv Neurol 2008. 89–90.
Bederson JB, Connolly Jr ES, Hunt Batjer H, Dacey RG, Dion JE, Diringer MN, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council American heart association. Stroke 2009;40(3):994–1025. DOI: 10.1161/STROKEAHA.108.191395.
Rincon F, Rossenwasser RH, Dumont A. The epidemiology of admissions of nontraumatic subarachnoid hemorrhage in the United States. Neurosurgery 2013;3(2):217–222. DOI: 10.1227/01.neu.0000430290.93304.33.
Cohen-Gadol AA, Bohnstedt BN. Recognition and evaluation of nontraumatic subarachnoid hemorrhage and ruptured cerebral aneurysm. Am Fam Physician 2013;88:451–456.
Ju YE, Schwedt TJ. Abrupt-onset severe headaches. Semin Neurol 2010;30(02):192–200. DOI: 10.1055/s-0030-1249229.
Liebenberg WA, Worth R, Firth GB, Olney J, Norris JS. Aneurysmal subarachnoid haemorrhage: guidance in making the correct diagnosis. Postgrad Med J 2005;81(957):470–473. DOI: 10.1136/pgmj.2004.023788.
Pierot LG, Gawlitza M, Soize S. Unruptured intracranial aneurysms: it is not a bomb. Rev Neurol 2017;173(9):530–531. DOI: 10.1016/j.neurol.2017.05.018.
Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, et al., UCAS Japan##The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Eng J Med 2012;366(26):2474–2482. DOI: 10.1056/NEJMoa1113260.
Juvela S, Korja M. Intracranial aneurysm parameters for predicting a future subarachnoid hemorrhage: a long-term follow-up study. Neurosurgery 2017;81(3):432–440. DOI: 10.1093/neuros/nyw049.
Broderick JP, Viscoli CM, Brott T, Kernan WN, Brass LM, Feldmann E, et al. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke 2003;34(6):1375–1381. DOI: 10.1161/01.STR.0000074572.91827.F4.
Kleinloog RD, de Mul N, Verweij BH, Post JA, Rinkel GJE, Ruigrok YM. Risk factors for intracranial aneurysm rupture: a systematic review. Neurosurgery 2018;82(4):431–440. DOI: 10.1093/neuros/nyx238.
Rehman S, Sahle BW, Chandra RV, Dwyer M, Thrift AG, Callisaya M, et al. Sex differences in risk factors for aneurysmal subarachnoid haemorrhage. J Neurolog Sci 2019;406:116446. DOI: 10.1016/j.jns.2019.116446.
Feigin VL, Rinkel GJE, Lawes CMM, Algra A, Bennett DA, van Gijn J, et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005;36(12):2773–2780. DOI: 10.1161/01.STR.0000190838.02954.e8.
Almdal TS, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med 2004;164(13):1422–1426. DOI: 10.1001/archinte.164.13.1422.
O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376(9735):112–123. DOI: 10.1016/S0140-6736(10)60834-3.
Guimond JG, Chagnon P-M, Bojanowski MW. Clipping vs. Coiling in acute aneurysmal subarachnoid haemorrhage: should the patient's medical condition influence treatment modality. Neuro-Chirurgie 2012;58(2-3):115–124. DOI: 10.1016/j.neuchi.2012.02.012.
de Rooij NK, Linn FHH, van der Plas JA, Algra A, Rinkel GJE. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007;78(12):1365–1372. DOI: 10.1136/jnnp.2007.117655.
Aggarwal AS, Salunke P, Singh H, Kumar Gupta S, Chhabra R, Singla N, et al. Vasospasm following aneurysmal subarachnoid hemorrhage: thrombocytopenia a marker. J Neurosci Rural Pract 2013;4(3):257–261. DOI: 10.4103/0976-3147.118762.
Cowan J, Dimick JB, Wainess RM, Upchurch Jr GR, Thompson BG. Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral. J Neurosurg 2004;99(6):947–952. DOI: 10.3171/jns.2003.99.6.0947.
Wiebers DO, Whisnant JP, Huston 3rd J, Meissner I, Brown Jr RD, Piepgras DG, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003;362(9378):103–110. DOI: 10.1016/S0140-6736(03)13860-3.
Eden SV, Meurer WJ, Sánchez BN, Lisabeth LD, Smith MA, Brown DL. Gender and ethnic differences in subarachnoid hemorrhage. Neurology 2008;71(10):731–735. DOI: 10.1212/01.wnl.0000319690.82357.
De Marchis GM, Schaad C, Fung C, Beck J, Gralla J, Takala J. Gender-related differences in aneurysmal subarachnoid hemorrhage: a hospital based study. Clin Neurol Neurosurg 2017;157:82–87. DOI: 10.1016/j.clineuro.2017.04.009.
Cebral JR, Mut F, Weir J, Putman CM. Association of hemodynamic characteristics and cerebral aneurysm rupture. AJNR Am J Neuroradiol 2011;32(2):264–270. DOI: 10.3174/ajnr.A2274.
Suwatcharangkoon SM, Meyers E, Falo C, Schmidt JM, Agarwal S, Claassen J, et al. Loss of consciousness at onset of subarachnoid hemorrhage as an important marker of early brain injury. JAMA Neurol 2016;73(1):28–35. DOI: 10.1001/jamaneurol.2015.3188.
Can AC, Castro VM, Ozdemir YH, Dagen S, Dligach D, Finan S, et al. Alcohol consumption and aneurysmal subarachnoid hemorrhage. Transl Stroke Res 2018;9(1):13–19. DOI: 10.1007/s12975-017-0557-z.
Chalouhi NA, Chalouhi N, Ali MS, Starke RM, Jabbour PM, Tjoumakaris SI, et al. Cigarette smoke and inflammation: role in cerebral aneurysm formation and rupture. Mediators Inflamm 2012;2012:271582. DOI: 10.1155/2012/271582.
Nuki YT, Tsou T-L, Kurihara C, Kanematsu M, Kanematsu Y, Hashimoto T. Elastase-induced intracranial aneurysms in hypertensive mice. Hypertension 2009;54(6):1337–1344. DOI: 10.1161/HYPERTENSIONAHA.109.138297.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87(1):4–14. DOI: 10.1016/j.diabres.2009.10.007.
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010. Lancet 2012;380(9859):2197–2223. DOI: 10.1016/S0140-6736(12)61689-4.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl 1):S62–S69. DOI: 10.2337/dc11-S062.