Abstract
Objective: The incidence of subarachnoid hemorrhage (SAH) in the young is increasing recently. Among the young patients, some of them do not have detectable aneurysms, so the cause of the disease may be non-aneurysmal. In this study, we analyzed some clinical cases of subarachnoid hemorrhage in young adults and discussed the possible causes other than present aneurysm and arteriovenous malformation (AVM).
Methods: We reviewed 11 patients with SAH below 45 years of age enrolled in our hospital from January 2007 to June 2008. Their clinical characteristics, imaging examination results were analyzed in details: nine patients were found with no obvious cause for their hemorrhage. Four of them were followed up for 1year and the other three were followed up for half a year. We telephoned the seven patients to gain the information on their recovery by questionnaire.
Results: With an average onset age of 38 years old, all patients had similar symptoms and onset behavior according to their clinical characteristics. Based on the imaging results, two had confirmed vascular malformation; the other nine did not present detectable aneurysm or AVM, but with different morphological changes of their cerebral arteries. By 1-year or half-year follow-up, the seven patients were found to have good recovery.
Conclusion: Pathological changes of cerebral vessels due to smoking, genetic, or as an early version of formation of aneurysm, might be contributed to SAH in the young. Repeated angiogram is necessary for young patients to confirm the cause of SAH.
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References
Linn FH, Rinkel GJE, van Gijn J. Incidence of subarachnoid haemorrhage: role of region, year, and rate of computed tomography: a meta-analysis. Stroke 1996;27:625–9.
ACROSS Group. Epidemiology of aneurismal subarachnoid haemorrhage in Australia and New Zealand. Incidence and case-fatality from the Australasian Cooperative Research on Subarachnoid Haemorrhage Study (ACROSS). Stroke 2000;31:1843–50.
Hop JW, Rinkel GJE, Algra A, van Gijn J. Case-fatality and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 1997;28:660–4.
Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain 2000;123(2):205–21.
Arimura H, Li Q, Korogi Y. Computerized detection of intracranial aneurysms for three – dimensional MR angiography: feature extraction of small protrusions based on a shape – based difference image technique. Med Phys. 2006;33(2):394–401.
Howington JU, Kutz SC, Wilding GE, Awasthi D. Cocaine use as a predictor of outcome in aneurysmal subarachnoid haemorrhage. Neurosurgery 2003;99:271–75.
Teksam M, McKinney A, Casey S. Multi-section CT angiography for detection of cerebral aneurysms. AJNR Am J Neuroradiol. 2004;25:1485–92.
Chen W, Wang J. Accuracy of 16-row multislice computerized tomography angiography for assessment of intracranial aneurysms. Surg Neurol. 2009;71:32–42.
Hasan D, Lindsay KW, Wijdicks EF, Murray GD, Brouwers PJ, Bakker WH, et al. Effect of fludrocortisone acetate in patients with subarachnoid hemorrhage. Stroke 1989;20:1156–61.
Winn HR, Richardson AE, Jane JA. The long-term prognosis in untreated cerebral aneurysms: I The incidence of late hemorrhage in cerebral aneurysm: a 10-year evaluation of 364 patients. Ann Neurol. 1977;1:358–70.
Juvela S. Risk factors for multiple intracranial aneurysms. Stroke 2000;31:392–7.
Ellamushi HE, Grieve JP, Jager HR, Kitchen ND. Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg. 2001;94:728–32.
Connolly ES Jr, Choudhri TF, Mack WJ, Mocco J, Spinks TJ, Slosberg J, et al. Influence of smoking, hypertension, and sex on the phenotypic expression of familial intracranial aneurysms in siblings. Neurosurgery 2001;48:64–9.
Feigin V, Parag V, Lawes CM, Rodgers A, Suh I, Woodward M, et al. Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the asia-pacific region: an overview of 26 cohorts involving 306, 620 participants. Stroke 2005;36:1360–5.
Kurth T, Kase CS, Berger K, Gaziano JM, Cook NR, Buring JE. Smoking and risk of hemorrhagic stroke in women. Stroke 2003;34:2792–5.
Matsumoto K, Akagi K, Abekura M. Cigarette smoking increases the risk of developing a cerebral aneurysm and of subarachnoid hemorrhage9. Neurol Surg. 1999;27:(9): 831–5.
Tu YK, Ueng SWN. The effects of cigarette smoking on rabbit tibial vascular endothelium. Musculoskeletal Res. 2001;5(4):235–42.
Karl L, Hans JR, Paul K. Cigarette smoking and vascular pathology in renal biopsies. Kidney Int. 2002;61:648–54.
Butler R, Morris AD, Struthers AD. Cigarette smoking in men and vascular responsiveness. Clin Pharmacol. 2001;52:145–9.
Ritz E, Benck U, Franek E. Effects of smoking on renal hemodynamics in healthy volunteers and in patients with glomerular disease. J Am Soc Nephrol. 1998;9:1798–804.
Gambaro G, Verlato F, Budakovic A. Renal impairment in chronic cigarette smokers. J Am Soc Nephrol. 1998;9:562–7.
Benck U, Clorius JH, Zuna I. Renal hemodynamic changes during smoking: effects of adrenoreceptor blockade. Clin Invest. 1999;29:1010–8.
Hawkins RI. Smoking, platelets and thrombosis. Nature 1972;236:450–2.
Barrow SE, Ward PS, Sleightholm MA. Cigarette smoking: profiles of thromboxane- and prostacyclin-derived products in human urine. Biochim Biophys Acta. 1989;993:121–7.
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Wang, T., Zhang, J.H., Qin, X. (2011). Non-Aneurysm Subarachnoid Hemorrhage in Young Adults. In: Feng, H., Mao, Y., Zhang, J.H. (eds) Early Brain Injury or Cerebral Vasospasm. Acta Neurochirurgica Supplements, vol 110/1. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0353-1_36
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DOI: https://doi.org/10.1007/978-3-7091-0353-1_36
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