Influence of Triggering Events on the Occurrence of Spontaneous Intracranial Hemorrhage : Comparison of Non-Lesional Spontaneous Intraparenchymal Hemorrhage and Aneurysmal Subarachnoid Hemorrhage

Abstract

Objective : Spontaneous intracranial hemorrhage is a life-threatening disease, and non-lesional spontaneous intraparenchymal hemorrhage (nIPH) and aneurysmal subarachnoid hemorrhage (aSAH) are the leading causes of spontaneous intracranial hemorrhage. Only a few studies have assessed the association between prior physical activity or triggering events and the occurrence of nIPH or aSAH. The purpose of this study is to investigate the role of specific physical activities and triggering events in the occurrence of nIPH and aSAH. Methods : We retrospectively reviewed 824 consecutive patients with spontaneous intracranial hemorrhage between January 2010 and December 2018. Among the 824 patients, 132 patients were excluded due to insufficient clinical data and other etiologies of spontaneous intracranial hemorrhage. The medical records of 692 patients were reviewed, and the following parameters were assessed : age, sex, history of hypertension, smoking, history of stroke, use of antiplatelet or anticoagulation agents, season and time of onset, physical activities performed according to the metabolic equivalents, and triggering event at onset. Events that suddenly raised the blood pressure such as sudden postural changes, defecation or urination, sexual intercourse, unexpected emotional stress, sauna bath, and medical examination were defined as triggering events. These clinical data were compared between the nIPH and aSAH groups. Results : Both nIPH and aSAH most commonly occurred during non-strenuous physical activity, and there was no significant difference between the two groups (p=0.524). Thirty-two patients (6.6%) in the nIPH group and 39 patients (8.1%) in the aSAH group experienced triggering events at onset, and there was a significant difference between the two groups (p=0.034). The most common triggering events were defecation or urination in both groups. Conclusion : Specific physical activity dose no affect the incidence of nIPH and aSAH. The relationship between the occurrence of intracranial hemorrhage and triggering events is higher in aSAH than nIPH.

Potential triggering factors associated with aneurysmal subarachnoid hemorrhage: A large single‐center retrospective study

“…16 Another study in 2020 indicated that aSAH most commonly occurred during nonstrenuous physical activity. 17 From various perspectives, our study reviewed and summarized morbidity characteristics in aSAH patients admitted to Beijing Tiantan Hospital between 2015 and 2020. Our study showed a higher aSAH incidence, advanced age, and smaller mean maximum diameter of the aneurysm in female patients, consistent with previous studies.…”

“…One study in 2007 demonstrated that aneurysmal rupture occurred most frequently when patients were talking, chatting, watching television, or at home without any strenuous physical activity, and hypertension was the most common pre‐existing medical problem 16 . Another study in 2020 indicated that aSAH most commonly occurred during nonstrenuous physical activity 17 . However, highlighting events by patients’ actions may lead to more intuitive recommendations for patients.…”