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Acta Neurochirurgica

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01-12-2009 | Clinical Article

Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan

Author: Tetsuji Inagawa

Published in: Acta Neurochirurgica | Issue 12/2009

Abstract

Background

A community-based study was conducted to estimate the incidence rates of multiple aneurysms and to investigate the factors related to multiplicity.

Method

The subjects were 291 patients with ruptured saccular aneurysms treated between 1980 and 1998, in Izumo, Japan. There were 403 aneurysms in total, and 78 patients (27%) had multiple aneurysms.

Findings

Both the crude and the age- and sex-adjusted annual incidence rates per 100,000 population for multiple and single aneurysms were five and 14 for all ages, respectively, and were higher in women than in men. The age-specific incidence rates of both multiple and single aneurysms showed a tendency to increase with age. Of the 190 patients who underwent four-vessel studies, 26% (49) had multiple aneurysms. The frequencies of multiple aneurysms in patients with ruptured aneurysms ≥10 and <10 mm in diameter were 41% and 21%, respectively (p = 0.0081). In patients with multiple aneurysms, the number of aneurysms was greater in those with large ruptured aneurysms, and the unruptured aneurysms tended to be larger in patients with large ruptured aneurysms. The size of the ruptured aneurysms was positively associated with multiplicity, whereas hypertension had an inverse association. Age, sex, aneurysm site and risk factors other than hypertension were not predictive.

Conclusions

This study is the first to provide annual incidence rates for multiple aneurysms in a defined population. It appears that multiplicity of aneurysms is associated with larger ruptured aneurysms and that patients with larger ruptured aneurysms have a higher number of aneurysms as well as larger unruptured aneurysms.

Andrews RJ, Spiegel PK (1979) Intracranial aneurysms. Age, sex, blood pressure, and multiplicity in an unselected series of patients. J Neurosurg 51:27–32CrossRefPubMed

Berry RG, Alpers BJ, White JC (1966) The site, structure and frequency of intracranial aneurysms, angiomas and arteriovenous abnormalities. Res Publ Assoc Res Nerv Ment Dis 41:40–72PubMed

Chason JL, Hindman WM (1958) Berry aneurysms of the circle of Willis; results of a planned autopsy study. Neurology 8:41–44PubMed

Crompton MR (1966) Mechanism of growth and rupture in cerebral berry aneurysms. Br Med J 1:1138–1142CrossRefPubMed

Ellamushi HE, Grieve JP, Jager HR, Kitchen ND (2001) Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 94:728–732CrossRefPubMed

Freytag E (1966) Fatal rupture of intracranial aneurysms. Survey of 250 medicolegal cases. Arch Pathol 81:418–424PubMed

Housepian EM, Pool JL (1958) A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956. J Neuropathol Exp Neurol 17:409–423CrossRefPubMed

Inagawa T (1990) Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 106:119–126CrossRef

Inagawa T (1991) Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien) 108:22–29CrossRef

10.

Inagawa T (1997) What are the actual incidence and mortality rates of subarachnoid hemorrhage? Surg Neurol 47:47–53CrossRefPubMed

11.

Inagawa T (2001) Trends in incidence and case fatality rates of aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Stroke 32:1499–1507PubMed

12.

Inagawa T (2002) What are the actual incidence and mortality rates of intracerebral hemorrhage? Neurosurg Rev 25:237–246CrossRefPubMed

13.

Inagawa T (2005) Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan. J Neurosurg 102:60–67CrossRefPubMed

14.

Inagawa T (2005) Trends in surgical and management outcomes in patients with aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Cerebrovasc Dis 19:39–48CrossRefPubMed

15.

Inagawa T (2009) Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan. Surg Neurol (in press)

16.

Inagawa T, Hada H, Katoh Y (1992) Unruptured intracranial aneurysms in elderly patients. Surg Neurol 38:364–370CrossRefPubMed

17.

Inagawa T, Hirano A (1990) Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 34:361–365CrossRefPubMed

18.

Inagawa T, Hirano A (1990) Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol 33:117–123CrossRefPubMed

19.

Inagawa T, Ishikawa S, Aoki H, Takahashi M, Yoshimoto H (1988) Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Incidence. Stroke 19:170–175

20.

Inagawa T, Shibukawa M, Inokuchi F, Tokuda Y, Okada Y, Okada K (2000) Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City. Japan. Part II: management and surgical outcome. J Neurosurg 93:967–975

21.

Inagawa T, Takahashi M, Aoki H, Ishikawa S, Yoshimoto H (1988) Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Outcome. Stroke 19:176–180

22.

Inagawa T, Takechi A, Yahara K, Saito J, Moritake K, Kobayashi S, Fujii Y, Sugimura C (2000) Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City. Japan. Part I: incidence and seasonal and diurnal variations. J Neurosurg 93:958–966

23.

Inagawa T, Tokuda Y, Ohbayashi N, Takaya M, Moritake K (1995) Study of aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Stroke 26:761–766PubMed

24.

Inagawa T, Yoshimoto H, Aoki H, Ishikawa S, Takahashi M (1988) The incidence and outcome of aneurysmal subarachnoid hemorrhage in relation to the size of the geographic area (in Japanese). Jpn J Stroke 10:334–339

25.

International Study of Unruptured Intracranial Aneurysms Investigators (1996) Factors related to the development and detection of single versus multiple unruptured intracranial aneurysms. Stroke 27:178 Abstract

26.

Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, Tsuneyoshi M (1999) Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama Study. Stroke 30:1390–1395

27.

Juvela S (2000) Risk factors for multiple intracranial aneurysms. Stroke 31:392–397PubMed

28.

Kaminogo M, Yonekura M, Shibata S (2003) Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 34:16–21CrossRefPubMed

29.

Kongable GL, Lanzino G, Germanson TP, Truskowski LL, Alves WM, Torner JC, Kassell NF (1996) Gender-related differences in aneurysmal subarachnoid hemorrhage. J Neurosurg 84:43–48CrossRefPubMed

30.

McCaughey WTE (1956) Ruptured intracranial aneurysms. Ulster Med J 25:111–118PubMed

31.

McCormick WF (1973) Intracranial arterial aneurysm: a pathologist’s view. Curr Concepts Cererbrovasc Dis Stroke 8:15–19

32.

McCormick WF, Nofzinger JD (1965) Saccular intracranial aneurysms: an autopsy study. J Neurosurg 22:155–159CrossRefPubMed

33.

Menghini VV, Brown RD Jr, Sicks JD, O’Fallon WM, Wiebers DO (2001) Clinical manifestations and survival rates among patients with saccular intracranial aneurysms: population-based study in Olmsted County, Minnesota, 1965 to 1995. Neurosurgery 49:251–258CrossRefPubMed

34.

Nehls DG, Flom RA, Carter LP, Spetzler RF (1985) Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63:342–348CrossRefPubMed

35.

Ogungbo B, Gregson B, Mendelow AD (2003) Relation between age and number of aneurysms in patients with subarachnoid haemorrhage. Cerebrovasc Dis 16:454–455CrossRefPubMed

36.

Ohashi Y, Horikoshi T, Sugita M, Yagishita T, Nukui H (2004) Size of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol 61:239–247CrossRefPubMed

37.

Østergaard JR, Høg E (1985) Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 63:49–55

38.

Pleizier CM, Ruigrok YM, Rinkel GJ (2002) Relation between age and number of aneurysms in patients with subarachnoid haemorrhage. Cerebrovasc Dis 14:51–53CrossRefPubMed

39.

Qureshi AI, Suarez JI, Parekh PD, Sung G, Geocadin R, Bhardwaj A, Tamargo RJ, Ulatowski JA (1998) Risk factors for multiple intracranial aneurysms. Neurosurgery 43:22–27CrossRefPubMed

40.

Qureshi AI, Sung GY, Suri MFK, Straw RN, Guterman LR, Hopkins LN (2000) Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location. Neurosurgery 46:44–50CrossRefPubMed

41.

Rinne J, Hernesniemi J, Puranen M, Saari T (1994) Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 35:803–808CrossRefPubMed

42.

Schoenberg BS (1983) Calculating confidence intervals for rates and ratios: simplified method utilizing tabular values based on the Poisson distribution. Neuroepidemiology 2:257–265CrossRef

43.

Stehbens WE (1963) Aneurysms and anatomical variation of cerebral arteries. Arch Pathol 75:45–64PubMed

44.

Sugai M, Shoji M (1968) Pathogenesis of so-called congenital aneurysms of the brain. Acta Pathol Jpn 18:139–160PubMed

45.

Wilson G, Riggs HE, Rupp C (1954) The pathologic anatomy of ruptured cerebral aneurysms. J Neurosurg 11:128–134CrossRefPubMed

Title: Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan
Author: Tetsuji Inagawa
Publication date: 01-12-2009
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 12/2009
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-009-0479-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan

Abstract

Background

Method

Findings

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Findings

Conclusions

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