Trigger factors for rupture of intracranial aneurysms in relation to patient and aneurysm characteristics

J Neurol. 2012 Jul;259(7):1298-302. doi: 10.1007/s00415-011-6341-1. Epub 2011 Dec 21.

Abstract

Female gender, age above 60 years, and an aneurysm larger than 5 mm or location on the posterior circulation are associated with a higher rupture risk of intracranial aneurysms. We hypothesized that this association is explained by a higher susceptibility to (one of) the eight trigger factors that were recently identified. We included 250 patients with aneurysmal subarachnoid hemorrhage. We calculated relative risks (RR) with 95% confidence intervals (95% CI) of aneurysmal rupture for trigger factors according to sex, age, site, and size of the aneurysms by means of the case-crossover design. None of the triggers except for physical exercise differed according to patient and aneurysm characteristics. In the hour after exposure to physical exercise: (1) patients over the age of 60 have a six-times-higher risk of rupture (RR 13; 95% CI 6.3-26) than those of 60 years of age and under (RR 2.3; 1.3-4.1); (2) aneurysms at the internal carotid artery have a higher risk than those at other locations (RR 17; 7.8-37), but this was only statistically significant when compared to anterior communicating artery aneurysms (RR 3.2; 1.6-6.1); (3) aneurysms 5 mm or smaller had a higher risk of rupture (RR 9.5; 4.6-19) than larger aneurysms (RR 2.4; 1.3-4.3); and (4) women and men had similar risks. A higher susceptibility to exercise might explain part of the higher risk of rupture in older patients. Why women and patients with aneurysms larger than 5 mm or posterior circulation aneurysms have a higher risk of rupture remains to be settled.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / epidemiology*
  • Aneurysm, Ruptured / pathology
  • Confidence Intervals
  • Cross-Over Studies
  • Female
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / epidemiology*
  • Middle Aged
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Subarachnoid Hemorrhage / epidemiology*
  • Subarachnoid Hemorrhage / etiology