Circumstances Precipitating Aneurysmal Subarachnoid Hemorrhage

Abstract

To determine the precipitating factors of aneurysmal rupture, the medical records of 425 consecutive patients with aneurysmal subarachnoid hemorrhage were reviewed. As for the time of onset, a significantly higher incidence was found between 06.00 and 09.00 h and 18.00 and 21.00 h. Aneurysmal rupture occurred most frequently during talking, watching TV or staying home without any strenuous physical activity. The highest peak incidence considering the time spent was found during defecation and/or micturition. There was no evidence that aneurysmal rupture was prone to occur during physical work, either at the workplace or at home. Hypertension was the most common preexisting disease.

Involvement of Meteorological Factors and Sex in the Occurrence of Subarachnoid Hemorrhage in Japan

“…2,4,6,11,12,14,15,17,18,20,22,24,26,27,[29][30][31][32][33] Hospital-based and populationbased studies that demonstrated significant seasonal variation found that the peak period for SAH differed widely. [4][5][6]15,20,24,26,32,33) No statistically significant seasonal variations were also observed in some studies.…”

“…[4][5][6]15,20,24,26,32,33) No statistically significant seasonal variations were also observed in some studies. 2,12,14,17,22,27,[29][30][31] The highest occurrences of SAH were found in spring in women and in late fall in men, 4) in spring and fall in men, and in winter in women, 24) and in winter in women and no peak in men. 32) Our data resembled the results of 10 years of the Canadian Collaborative Study Group although the lowest occurrence in their male group was in summer whereas that of in the present study was in winter.…”

“…8,13) However, investigation of the seasonal incidence of SAH has identified environmental and sociomedical factors correlated with aneurysm rupture. 2,4,6,11,12,14,15,17,18,20,22,24,26,27,[29][30][31][32][33] The present study investigated the relationship between sex and seasonal occurrence of SAH.…”

Triggers of Subarachnoid Hemorrhage

“…8, 9 The 1 previous case-crossover 10 investigation suggested that vigorous physical activity increased the risk of SAH 15-fold. However, this study was based on a small series of patients, and the methods used for the case-crossover analysis were not standard because assumptions were made about patterns of exertion in the reference period.…”

“…6,7 A similar effect of physical exertion may hold for SAH 8 because it is commonly held that the acute event is often precipitated by a transient rise in blood pressure associated with sneezing, coitus, micturition or defecation, extreme physical activity, or a sudden emotional shock. 8,9 However, this perception is based mainly on anecdotal reports and studies of selected series of patients in which issues of bias and confounding have not always been addressed. Although a recent population-based study found the relative risk of sustaining SAH during vigorous activity to be 11.6 and 15.0 in case-control and case-crossover analyses, respectively, the small number of cases and complexities of analysis raise uncertainty about the estimates.…”