Recent Infection as a Risk Factor for Intracerebral and Subarachnoid Hemorrhages

Kunze, A.; Annecke, Andrea; Wigger, Frank; Lichy, Christoph; Buggle, Florian; Schnippering, Holger; Schnitzler, Paul; Grau, Armin J.

doi:10.1159/000016090

Cited by 24 publications

(33 citation statements)

References 15 publications

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“…The evidence on recent infection in relation to the incidence of SAH is limited. 14,24,30,52,58 The results of a Canadian study from the Calgary region were comparable with our findings and showed a small but significant increase in the incidence of SAH during influenza epidemics, with a delay between increased influenza and SAH rates of 0.9 week. 14 A case-control study found that an upper respiratory tract infection was an independent trigger factor for SAH, but this study included only 44 patients.…”

Section: Discussionsupporting

confidence: 89%

“…In addition, this study's retrospective design, in which patients were asked if they had infections within 4 weeks prior to hospitalization, might have led to recall bias. 30 A case-crossover study on trigger factors for SAH found a relative risk of 2.4 (95% CI 0.3-16) for flu-like illness during the 24 hours prior to SAH. 58 Two other small case-control studies investigated antibody serum titers of influenza and other viral infections in patients with aneurysmal SAH.…”

Section: Discussionmentioning

confidence: 99%

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Increased incidence of subarachnoid hemorrhage during cold temperatures and influenza epidemics

Backes¹,

Rinkel²,

Algra

et al. 2016

JNS

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OBJECTIVE This study investigated whether the increased incidence of aneurysmal subarachnoid hemorrhage (SAH) in winter is related to temperature or increased incidence of influenza. Such relationships may elucidate the pathogenesis of intracranial aneurysm rupture. METHODS A nationwide sample of 18,714 patients with SAH was linked with weekly temperature and influenza-like illness consultation data. Poisson regression analyses were used to calculate incidence density ratios (IDRs) with corresponding 95% CIs for the association of SAH incidence with temperature and influenza epidemics; IDRs were adjusted for study year (aIDR). In addition, SAH incidence data from 30 European population-based studies were linked with daily temperature data from the European Climate Assessment. RESULTS The aIDR for SAH during influenza epidemics was 1.061 (95% CI 1.022–1.101) in the univariable and 1.030 (95% CI 0.989–1.074) in the multivariable analysis. This association declined gradually during the weeks after epidemics. Per 1°C temperature drop, the aIDR was 1.005 (95% CI 1.003–1.008) in the univariable and 1.004 (95% CI 1.002–1.007) in the multivariable analysis. In the European population-based studies, the IDR was 1.143 (95% CI 1.129–1.157) per 1°C temperature drop. CONCLUSIONS The incidence of SAH is increased during cold temperatures and epidemic influenza. Future studies with individual patient data are needed to investigate causality between temperature or influenza and SAH.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Increased incidence of subarachnoid hemorrhage during cold temperatures and influenza epidemics

Backes¹,

Rinkel²,

Algra

et al. 2016

JNS

View full text Add to dashboard Cite

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“…Most longitudinal studies were initiated in the 1970s and were restricted to the US, Japanese, UK, Korean, and Finnish populations. Of the 23 case-control studies, 10 (63% of SAH cases) [12][13][14][15][16][17][18][19][20][21] were population based and 13 hospital based, [22][23][24][25][26][27][28][29][30][31][32][33][34] covering a variety of populations: American (United States), Latin American (Chile, Colombia, Mexico, Brazil, and Jamaica), European (Norway, Germany, Hungary, Portugal, Denmark, Yugoslavia, Slovenia, Finland, and the United Kingdom), African (Kenya, Zambia, and Zimbabwe), and Australasian (China, Indonesia, Thailand, Australia, New Zealand, and Japan). Overall, 3936 cases of SAH (892 cases in longitudinal studies [9 223 763 person-years of follow-up] and 3044 cases in case-control studies) were available for the analysis, thus allowing 1984 more cases of SAH to be analyzed than in the previous overview.…”

Section: Resultsmentioning

confidence: 99%

“…Our finding that most risk factors tend to be more hazardous in women than in men, although this difference is statistically nonsignificant, suggests that this may contribute to the higher incidence of SAH observed in women. Case-control 12,14,22,24,26,27 0.7 (0.5-0.8) †Totals represent pooled estimates for all available studies reporting data for both men and women separately or combined; there were a different No. of studies that contributed data to the overall effect estimates and No.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Subarachnoid Hemorrhage

Feigin

Rinkel

Lawes

et al. 2005

Stroke

666

300

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Background and Purpose-After a 1996 review from our group on risk factors for subarachnoid hemorrhage (SAH), much new information has become available. This article provides an updated overview of risk factors for SAH. Methods-An overview of all longitudinal and case-control studies of risk factors for SAH published in English from 1966 through March 2005. We calculated pooled relative risks (RRs) for longitudinal studies and odds ratios (ORs) for case-control studies, both with corresponding 95% CIs. Results-We included 14 longitudinal (5 new) and 23 (12 new) case-control studies. Overall, the studies included 3936 patients with SAH (892 cases in 14 longitudinal studies and 3044 cases in 23 case-control studies) for analysis.

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“…In addition, recent systemic infection has been postulated as a trigger for subarachnoid hemorrhage in adults, perhaps related to the formation and rupture of aneurysms. 6 Association studies examining environmental risk factors for hemorrhage from vascular lesions in children are lacking. We hypothesized that antecedent recent infection or trauma may predispose children to incident hemorrhage from vascular lesions.…”

Section: Discussionmentioning

confidence: 99%

Role of trauma and infection in childhood hemorrhagic stroke due to vascular lesions

Singhal¹,

Hills²,

Fullerton³

2013

Neurology

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Objective: Trauma and infection have been postulated as "triggers" for hemorrhage from underlying brain vascular lesions (arteriovenous malformations, cavernous malformations, and aneurysms) in pediatric hemorrhagic stroke. We decided to perform an association study examining these environmental risk factors.Methods: In this case-control study nested within the cohort of 2.3 million children enrolled in a Northern California integrated health plan (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004), we identified childhood hemorrhagic stroke cases through electronic searches of diagnostic and radiology databases, confirmed through chart review. Three age-and facility-matched controls per case were randomly selected from the study population. Exposure variables were measured using medical records documented before stroke diagnosis. Main outcome measure was hemorrhagic stroke.Results: Of 132 childhood, non-neonatal hemorrhagic stroke cases, 65 had underlying vascular lesions: 34 arteriovenous malformations, 16 cavernous malformations, and 15 aneurysms. A documented exposure to head and neck trauma in the prior 12 weeks was present in 3 cases (4.6%) with underlying vascular lesions, compared with no controls (p , 0.015). However, all 3 vascular lesions were aneurysms, and traumatic pseudoaneurysms were possible. Recent minor infection (prior 4 weeks) was present in 5 cases (7.7%) and 9 controls (4.6%) (p 5 0.34).Conclusions: Our observed association between trauma and hemorrhagic stroke with a vascular lesion may be explained by traumatic pseudoaneurysms. Neither recent head or neck trauma nor infection appeared to be a "trigger" for pediatric hemorrhagic stroke due to underlying vascular malformations. Neurology Hemorrhagic strokes account for 50% of all childhood strokes 1 and are devastating: up to onethird die and 40% have permanent neurologic deficits.2,3 Of all pediatric hemorrhagic strokes, vascular lesions (arteriovenous malformations, cavernous malformations, or aneurysm) account for nearly 50%. 4 To date, most studies have evaluated secondary hemorrhage risk factors in terms of intrinsic characteristics of malformations, 5 but risk factors related to what promotes primary hemorrhage have not been evaluated. As more vascular malformations are discovered as incidental findings on imaging studies, it is increasingly important to identify factors promoting hemorrhage from these otherwise asymptomatic lesions.Neurosurgeons and neurologists anecdotally caution against contact sports for children with known vascular malformations or aneurysms because of concern that trauma could trigger a hemorrhage. In addition, recent systemic infection has been postulated as a trigger for subarachnoid hemorrhage in adults, perhaps related to the formation and rupture of aneurysms.6 Association studies examining environmental risk factors for hemorrhage from vascular lesions in children are lacking. We hypothesized that antecedent recent infection or trauma may predispose children to incident hemor...

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Recent Infection as a Risk Factor for Intracerebral and Subarachnoid Hemorrhages

Cited by 24 publications

References 15 publications

Increased incidence of subarachnoid hemorrhage during cold temperatures and influenza epidemics

Increased incidence of subarachnoid hemorrhage during cold temperatures and influenza epidemics

Risk Factors for Subarachnoid Hemorrhage

Role of trauma and infection in childhood hemorrhagic stroke due to vascular lesions

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