Predisposition of Sex and Aging to Ruptured Intracerebral Aneurysms: a Retrospective Study by 3DRA
Keywords:
subarachnoid hemorrhage; three-dimensional rotational angiography (3DRA); postmenopausal women; aging; multiple intracranial aneurysmsAbstract
Background and Objectives: Elderly people and postmenopausal women tend to have ruptured intracranial aneurysm. At present, three-dimensional rotational angiography (3DRA) is the new gold standard to detect vascular pathology. Therefore, this study aimed to investigate the prevalence of non-traumatic subarachnoid hemorrhage (SAH) patients with ruptured intracranial aneurysms regarding to sex and age of the patients, number of ruptured and unruptured aneurysms and ruptured aneurysm sites, based on 3DRA.
Methods: This retrospective study was performed on 3DRA of non-traumatic SAH patients. The numbers of patients in aneurysmal and non-aneurysmal groups were compared. The numbers of intracranial aneurysmal patients regarding to sex, age, all ruptured and unruptured aneurysms, and ruptured aneurysm sites were recorded and analyzed.
Results: The prevalence of subjects with ruptured intracranial aneurysm was 72.22% of 126 enrolled SAH patients. Of 91 intracranial aneurysmal subjects, the prevalence of females was 71.43%, as high as 2.5 times that of male. The percentage of aneurysmal patients aged between 50-79 years was higher than that of the subjects aged between 20-49 years. The prevalence of subjects with multiple aneurysms appeared in 14.29% of aneurysmal patients and predisposed to the female. The patients with ruptured aneurysms located outside the circle of Willis (CW) comprised 31.87%.
Conclusion: The prevalence of SAH patients with ruptured intracranial aneurysms was high in elderly people, especially postmenopausal women. This study also revealed the higher percentage of SAH patients with multiple aneurysms and the higher frequency of patients with ruptured aneurysms located outside the CW than the previous reports.
References
1. van Gijn J, Kerr RS, Rinkel GJE. Subarachnoid haemorrhage. Lancet 2007; 369: 306–18.
2. Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29 :251–6.
3. Stegmayr B, Eriksson M, Asplund K. Declining mortality from subarachnoid hemorrhage: changes in incidence and case fatality from 1985 through 2000. Stroke 2004; 35: 2059–63.
4. Larsen CC, Astrup J. Rebleeding after aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg 2013; 79: 307–12.
5. Eskesen V, Rosenørn J, Schmidt K. The impact of rebleeding on the life time probabilities of different outcomes in patients with ruptured intracranial aneurysms. A theoretical evaluation. Acta Neurochir (Wien) 1988; 95: 99–101.
6. Jeon P, Kim BM, Kim DJ, Kim DI, Suh SH. Treatment of multiple intracranial aneurysms with 1-stage coiling. AJNR Am J Neuroradiol 2014; 35: 1170–3.
7. Lee KC, Joo JY, Lee KS. False localization of rupture by computed tomography in bilateral internal carotid artery aneurysms. Surg Neurol 1996; 45: 435–40; discussion 440-1.
8. Bhat AR, Wani MA, Kirmani AR, Ramzan AU, Alam S, Raina T, et al. High incidence of intracranial aneurysmal subarachnoid hemorrhage (SAH) in Kashmir, India. Biomed Res 2011; 23: 79-92.
9. Kitkhuandee A, Thammaroj J, Munkong W, Duangthongpon P, Thanapaisal C. Cerebral angiographic findings in patients with non-traumatic subarachnoid hemorrhage. J Med Assoc Thai 2012; 95 (Suppl 11): S121-9.
10. Across Group. Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand: Incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke 2000; 31: 1843–50.
11. van Rooij WJ, Sprengers ME, de Gast AN, Peluso JPP, Sluzewski M. 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 2008; 29: 976–9.
12. Rossitti S, Löfgren J. Optimality principles and flow orderliness at the branching points of cerebral arteries. Stroke 1993; 24: 1029–32.
13. Stehbens WE. Etiology of intracranial berry aneurysms. J Neurosurg 1989; 70: 823–31.
14. Sforza DM, Putman CM, Cebral JR. Hemodynamics of Cerebral Aneurysms. Annu Rev Fluid Mech 2009; 41: 91–107.
15. Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, et al. Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab 2012; 32: 1659–76.
16. Ostergaard JR, Høg E. Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 1985; 63: 49–55.
17. Qureshi AI, Suarez JI, Parekh PD, Sung G, Geocadin R, Bhardwaj A, et al. Risk factors for multiple intracranial aneurysms. Neurosurgery. 1998; 43: 22–6; discussion 26-7.
18. Salehpour F. Multiple intracranial aneurysms and older age groups. EC Neurology 2015; 2: 153–4.
19. Imaizumi Y, Mizutani T, Shimizu K, Sato Y, Taguchi J. Detection rates and sites of unruptured intracranial aneurysms according to sex and age: an analysis of MR angiography-based brain examinations of 4070 healthy Japanese adults. J Neurosurg 2018; 1–6.
20. Tabuchi S. Relationship between postmenopausal estrogen deficiency and aneurysmal subarachnoid hemorrhage Behav Neurol [serial online] 2015 Oct 11 [cited Jun 1, 2018]; [6 screens]. Available from: https://bit.ly/2uNyWcE.
21. Prasit M, Sakondhavat C, Lao-unka K, Soontrapa S, Kaewrudee S, Somboonporn W, et al. Menopausal symptoms among women attending of the menopausal clinic at Srinagarind Hospital. Srinagarind Med J 2007; 22: 267–74.
22. Thomas F, Renaud F, Benefice E, De Meeüs T, Guegan J-F. International variability of ages at menarche and menopause: patterns and main determinants. Human Biology 2001; 73: 271–90.
23. Longstreth WT, Nelson LM, Koepsell TD, van Belle G. Subarachnoid hemorrhage and hormonal factors in women. A population-based case-control study. Ann Intern Med 1994; 121: 168–73.
24. Ingall TJ, Wiebers DO. Natural history of subarachnoid hemorrhage. In: Whisnant JP, editor. Stroke: populations, cohorts, and clinical trials. Oxford: Butterworth-Heinemann, 1993: 74–86.
25. Phuenpathom N, Ratanalert S, Sripairojkul B. Multiple intracranial aneurysms in Songklanagarind Hospital. J Med Assoc Thai 1998; 81: 75–9.
26. Navalitloha Y, Taechoran C, O’Chareon S. Multiple intracranial aneurysms: incidence and management outcome in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2000; 83: 1442–6.
27. Defillo A, Qureshi MH, Nussbaum ES. Are multiple intracranial aneurysms, more than 5 at one time, almost exclusively a female disease? A clinical series and literature review. J Neurol Stroke 2014; 1: 1–5.
28. Gaivas S, Rotariu D, Iliescu B, Ziyad F, Apetrei C, Poeată I. Multiple intracranial aneurysms: incidence and outcome in a series of 357 patients. Romanian Neurosurg 2011; 18: 450–5.
29. Juvela S. Risk factors for multiple intracranial aneurysms. Stroke 2000; 31: 392–7.
30. Ghods AJ, Lopes D, Chen M. Gender differences in cerebral aneurysm location. Front Neurol [serial online] 2012 Mar 27 [cited Jun 1, 2018];3:[6 screens]. Available from: https://bit.ly/2LjF5Yu
31. Stober T, Sen S, Anstätt T, Freier G, Schimrigk K. Direct evidence of hypertension and the possible role of post-menopause oestrogen deficiency in the pathogenesis of berry aneurysms. J Neurol 1985; 232: 67–72.
32. Kongable GL, Lanzino G, Germanson TP, Truskowski LL, Alves WM, Torner JC, et al. Gender-related differences in aneurysmal subarachnoid hemorrhage. J Neurosurg 1996; 84: 43–8.
33. Uysal E, Yanbuloğlu B, Ertürk M, Kilinç BM, Başak M. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage. Diagn Interv Radiol 2005; 11: 77–82.
34. Duong H, Melançon D, Tampieri D, Ethier R. The negative angiogram in subarachnoid haemorrhage. Neuroradiology 1996; 38: 15–9.
35. Kasuya H, Shimizu T, Nakaya K, Sasahara A, Hori T, Takakura K. Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms. Neurosurgery 1999; 45: 89–93; discussion 93-4.
36. Stojanović N, Stefanović I, Randjelović S, Mitić R, Bosnjaković P, Stojanov D. Presence of anatomical variations of the circle of Willis in patients undergoing surgical treatment for ruptured intracranial aneurysms. Vojnosanit Pregl 2009; 66: 711–7.
2. Rinkel GJ, Djibuti M, Algra A, van Gijn J. Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998; 29 :251–6.
3. Stegmayr B, Eriksson M, Asplund K. Declining mortality from subarachnoid hemorrhage: changes in incidence and case fatality from 1985 through 2000. Stroke 2004; 35: 2059–63.
4. Larsen CC, Astrup J. Rebleeding after aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg 2013; 79: 307–12.
5. Eskesen V, Rosenørn J, Schmidt K. The impact of rebleeding on the life time probabilities of different outcomes in patients with ruptured intracranial aneurysms. A theoretical evaluation. Acta Neurochir (Wien) 1988; 95: 99–101.
6. Jeon P, Kim BM, Kim DJ, Kim DI, Suh SH. Treatment of multiple intracranial aneurysms with 1-stage coiling. AJNR Am J Neuroradiol 2014; 35: 1170–3.
7. Lee KC, Joo JY, Lee KS. False localization of rupture by computed tomography in bilateral internal carotid artery aneurysms. Surg Neurol 1996; 45: 435–40; discussion 440-1.
8. Bhat AR, Wani MA, Kirmani AR, Ramzan AU, Alam S, Raina T, et al. High incidence of intracranial aneurysmal subarachnoid hemorrhage (SAH) in Kashmir, India. Biomed Res 2011; 23: 79-92.
9. Kitkhuandee A, Thammaroj J, Munkong W, Duangthongpon P, Thanapaisal C. Cerebral angiographic findings in patients with non-traumatic subarachnoid hemorrhage. J Med Assoc Thai 2012; 95 (Suppl 11): S121-9.
10. Across Group. Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand: Incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke 2000; 31: 1843–50.
11. van Rooij WJ, Sprengers ME, de Gast AN, Peluso JPP, Sluzewski M. 3D rotational angiography: the new gold standard in the detection of additional intracranial aneurysms. AJNR Am J Neuroradiol 2008; 29: 976–9.
12. Rossitti S, Löfgren J. Optimality principles and flow orderliness at the branching points of cerebral arteries. Stroke 1993; 24: 1029–32.
13. Stehbens WE. Etiology of intracranial berry aneurysms. J Neurosurg 1989; 70: 823–31.
14. Sforza DM, Putman CM, Cebral JR. Hemodynamics of Cerebral Aneurysms. Annu Rev Fluid Mech 2009; 41: 91–107.
15. Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, et al. Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab 2012; 32: 1659–76.
16. Ostergaard JR, Høg E. Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 1985; 63: 49–55.
17. Qureshi AI, Suarez JI, Parekh PD, Sung G, Geocadin R, Bhardwaj A, et al. Risk factors for multiple intracranial aneurysms. Neurosurgery. 1998; 43: 22–6; discussion 26-7.
18. Salehpour F. Multiple intracranial aneurysms and older age groups. EC Neurology 2015; 2: 153–4.
19. Imaizumi Y, Mizutani T, Shimizu K, Sato Y, Taguchi J. Detection rates and sites of unruptured intracranial aneurysms according to sex and age: an analysis of MR angiography-based brain examinations of 4070 healthy Japanese adults. J Neurosurg 2018; 1–6.
20. Tabuchi S. Relationship between postmenopausal estrogen deficiency and aneurysmal subarachnoid hemorrhage Behav Neurol [serial online] 2015 Oct 11 [cited Jun 1, 2018]; [6 screens]. Available from: https://bit.ly/2uNyWcE.
21. Prasit M, Sakondhavat C, Lao-unka K, Soontrapa S, Kaewrudee S, Somboonporn W, et al. Menopausal symptoms among women attending of the menopausal clinic at Srinagarind Hospital. Srinagarind Med J 2007; 22: 267–74.
22. Thomas F, Renaud F, Benefice E, De Meeüs T, Guegan J-F. International variability of ages at menarche and menopause: patterns and main determinants. Human Biology 2001; 73: 271–90.
23. Longstreth WT, Nelson LM, Koepsell TD, van Belle G. Subarachnoid hemorrhage and hormonal factors in women. A population-based case-control study. Ann Intern Med 1994; 121: 168–73.
24. Ingall TJ, Wiebers DO. Natural history of subarachnoid hemorrhage. In: Whisnant JP, editor. Stroke: populations, cohorts, and clinical trials. Oxford: Butterworth-Heinemann, 1993: 74–86.
25. Phuenpathom N, Ratanalert S, Sripairojkul B. Multiple intracranial aneurysms in Songklanagarind Hospital. J Med Assoc Thai 1998; 81: 75–9.
26. Navalitloha Y, Taechoran C, O’Chareon S. Multiple intracranial aneurysms: incidence and management outcome in King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2000; 83: 1442–6.
27. Defillo A, Qureshi MH, Nussbaum ES. Are multiple intracranial aneurysms, more than 5 at one time, almost exclusively a female disease? A clinical series and literature review. J Neurol Stroke 2014; 1: 1–5.
28. Gaivas S, Rotariu D, Iliescu B, Ziyad F, Apetrei C, Poeată I. Multiple intracranial aneurysms: incidence and outcome in a series of 357 patients. Romanian Neurosurg 2011; 18: 450–5.
29. Juvela S. Risk factors for multiple intracranial aneurysms. Stroke 2000; 31: 392–7.
30. Ghods AJ, Lopes D, Chen M. Gender differences in cerebral aneurysm location. Front Neurol [serial online] 2012 Mar 27 [cited Jun 1, 2018];3:[6 screens]. Available from: https://bit.ly/2LjF5Yu
31. Stober T, Sen S, Anstätt T, Freier G, Schimrigk K. Direct evidence of hypertension and the possible role of post-menopause oestrogen deficiency in the pathogenesis of berry aneurysms. J Neurol 1985; 232: 67–72.
32. Kongable GL, Lanzino G, Germanson TP, Truskowski LL, Alves WM, Torner JC, et al. Gender-related differences in aneurysmal subarachnoid hemorrhage. J Neurosurg 1996; 84: 43–8.
33. Uysal E, Yanbuloğlu B, Ertürk M, Kilinç BM, Başak M. Spiral CT angiography in diagnosis of cerebral aneurysms of cases with acute subarachnoid hemorrhage. Diagn Interv Radiol 2005; 11: 77–82.
34. Duong H, Melançon D, Tampieri D, Ethier R. The negative angiogram in subarachnoid haemorrhage. Neuroradiology 1996; 38: 15–9.
35. Kasuya H, Shimizu T, Nakaya K, Sasahara A, Hori T, Takakura K. Angles between A1 and A2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms. Neurosurgery 1999; 45: 89–93; discussion 93-4.
36. Stojanović N, Stefanović I, Randjelović S, Mitić R, Bosnjaković P, Stojanov D. Presence of anatomical variations of the circle of Willis in patients undergoing surgical treatment for ruptured intracranial aneurysms. Vojnosanit Pregl 2009; 66: 711–7.
Downloads
Published
2018-08-21
How to Cite
1.
Amarttayakong P, Woraputtaporn W, Prajaney P, Iamsaard S, Munkong W, Sangkhano S. Predisposition of Sex and Aging to Ruptured Intracerebral Aneurysms: a Retrospective Study by 3DRA. SRIMEDJ [Internet]. 2018 Aug. 21 [cited 2024 Apr. 27];33(5):480-7. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/141498
Issue
Section
Original Articles
