Aneurysmal subarachnoid haemorrhage (aSAH): Five consecutive years' experience of Fars province, Iran

Abstract

ObjectiveSubarachnoid haemorrhage (SAH), caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH) plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients’ characteristics over five consecutive years in Fars, a large province located in Southern Iran.MethodsIn this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery. Data from the last national census in 2011 were used to calculate the incidence. The data were analysed using SPSS software version 18 using independent sample t test, chi square test and ANOVA. The significance level was set at 0.05.ResultsThe number of aSAH cases identified in Fars, Iran, each year varied between 78 (2011) and 98 (2015) for a total of 421 aSAH cases within the 5-year study period. The annual aSAH incidence estimates showed no differences and were 1.65 [95% confidence interval (CI): 1.58–1.72], 1.70 (95%CI: 1.68–1.72), 1.71 (95%CI: 1.63–1.78), 1.82 (95%CI: 1.74–1.9), and 2.05 (95%CI: 1.97–2.13) per 100,000 persons, respectively, for the five consecutive years from 21 March 2011 to 20 March 2016. Hypertension was the most common risk factor, and was found in 198 (48%) aSAH patients. Ninety-four (22.5%) patients had moderate hydrocephalus on admission. Middle cerebral artery and anterior communicating artery were the most common sites of aneurysms. On admission, 351 (83%) patients had a Glasgow Coma Scale score >7, 197 (47%) presented with Hunt and Hess score of 1, and 365 (87%) had a Fisher score of ≤3. Multiple aneurysms were found in 59 (14%) of the 421 cases and the most common risk factors in multiple aneurysms were hypertension in 30 (51%) and smoking in 26 (44%) cases. Survival data were available only on patients diagnosed in year 2015, and the six-month survival rate was 89.8%.ConclusionsThis study revealed that although the incidence of aSAH remained stable, the survival of aSAH patients who reached the hospital alive and were operated on, improved in Shiraz (the six-month survival rate was 89.8% in year 2015). The incidence and survival study on aSAH in other geographic areas of Iran as a multi-centre study is recommended. There is a need to inform primary healthcare workers regarding the possibility of aSAH in a patient with signs of the sentinel headache.

Microsurgery of Cerebral Aneurysm: Epidemiological Profile

“…The present study found an average age of 53.53 AE 9.64 years old, which is equivalent to the mean age of patients undergoing cerebral aneurysm surgery found in several studies. According to the study by Rahmanian et al, 14 among the 421 patients studied, an average of 49.8 AE 1.5 years old was found. According to a 2018 study, analyzing 2,898 patients, obtained an average of 58.9 AE 14.3 years old.…”

“…According to a 2017 study, hypertension was observed in 47.1% of its patients. 14 In a study published in 2019, hypertensive patients corresponded to 43.82% of the sample. 17 A 2018 study showed that 31.2% were hypertensive.…”

“…15 Also, according to a study published in 2019, the carotid was the most affected system. 17 According to Rahmanian et al, 14 the anterior system was the most affected, and the middle cerebral artery was the most frequently affected vessel. It was not possible to find in the current literature a pathophysiological correlation that can demonstrate a higher frequency of involvement of the anterior circulation.…”

CD68 Antigen and Cerebral Aneurysms: A Case-Control Study

“…In a 5year investigation at our center, the MCA and the A-com a were the most commonly aneurysm sites among 421 aneurysmal subarachnoid cases. 2 In another study in our center, a significant correlation between levels of interleukin-1β (IL-1β) and outcome following aneurysmal SAH was found. 22 The mean age of the patients with ruptured and unruptured aneurysms was similar (about 49 years).…”

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Known risk factors for saccular aneurysm formation include hypertension, smoking, and various connective tissue disorders. 2 Computed tomography (CT) angiography, magnetic resonance angiography (MRA), and conventional angiography are Keywords ► cerebral aneurysm ► inflammation ► CD68 antigen ► Iran

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