Aneurysmal subarachnoid hemorrhage (aSAH)

Aneurysmal subarachnoid hemorrhage (aSAH)

Subarachnoid hemorrhage (SAH) following aneurysm bleeding accounts for 6% to 8% of all cerebrovascular accidents.

The anterior communicating artery aneurysm cause aneurysmal subarachnoid hemorrhage, about 21.0%~25.5% of percent of spontaneous subarachnoid hemorrhage 1) 2) 3).

The peak age for aneurysmal subarachnoid hemorrhage aSAH is 55-60 years, about 20% of cases occur between ages 15-45 yrs.

30% of aSAHs occurs during sleep

50% of patients with aneurysms have warning symptoms, usually 6-20 days before SAH

headache ls lateralized in 30%, most to the side of the aneurysm.

soft evidence suggests that rupture incidence is higher in spring and autumn

patients > 70 yrs age have a higher proportion with a severe neurologic grade.

The inherent variability in the incidence and presentation of ruptured cerebral aneurysms has been investigated in association with seasonality, circadian rhythm, lunar cycle, and climate factors.

Rosenbaum et al., aimed to identify an association between solar activity (solar flux and sunspots) and the incidence of aneurysmal SAH, all of which appear to behave in periodic fashions over long time periods. The Nationwide Inpatient Sample (NIS) provided longitudinal, retrospective data on patients hospitalized with SAH in the United States, from 1988 to 2010, who underwent aneurysmal clipping or coiling. Solar activity and SAH incidence data were modeled with the cosinor methodology and a 10-year periodic cycle length. The NIS database contained 32,281 matching hospitalizations from 1988 to 2010. The acrophase (time point in the cycle of highest amplitude) for solar flux and for sunspots were coincident. The acrophase for aneurysmal SAH incidence was out of phase with solar activity determined by non-overlapping 95% confidence intervals (CIs). Aneurysmal SAH incidence peaks appear to be delayed behind solar activity peaks by 64 months (95% CI; 56-73 months) when using a modeled 10-year periodic cycle. Solar activity (solar flux and sunspots) appears to be associated with the incidence of aneurysmal SAH. As solar activity reaches a relative maximum, the incidence of aneurysmal SAH reaches a relative minimum. These observations may help identify future trends in aneurysmal SAH on a population basis. 4).

By using high-quality meteorological data analyzed with a sophisticated and robust statistical method no clearly identifiable meteorological influence for the SAH events considered can be found. Further studies on the influence of the investigated parameters on SAH incidence seem redundant 5).

Evidence based information on the epidemiology, risk factors and prognosis, as well as recommendations on diagnostic work up, monitoring and management are provided, with regard to treatment possibilities in Croatia in the article of Solter et al. 6) 7).

There is high variability in the election of treatment modality among centres in Spain. Endovascular treatment allows more patients to have their aneurysm treated. Guideline adherence is moderate 8).


Suzuki M, Fujisawa H, Ishihara H, Yoneda H, Kato S, Ogawa A. Side selection of pterional approach for anterior communicating artery aneurysms–surgical anatomy and strategy. Acta Neurochir (Wien) 2008;150:31–39. 39.

Kimura T, Morita A, Shirouzu I, Sora S. Preoperative evaluation of unruptured cerebral aneurysms by fast imaging employing steady-state acquisition image. Neurosurgery. 2011;69:412–419. discussion 419-420.

Kwon SC, Park JB, Shin SH, Sim HB, Lyo IU, Kim Y. The Efficacy of Simultaneous Bilateral Internal Carotid Angiography during Coil Embolization for Anterior Communicating Artery Aneurysms. J Korean Neurosurg Soc. 2011;49:257–261

Rosenbaum BP, Weil RJ. Aneurysmal Subarachnoid Hemorrhage: Relationship to Solar Activity in the United States, 1988-2010. Astrobiology. 2014 Jun 30. [Epub ahead of print] PubMed PMID: 24979701.

Neidert MC, Sprenger M, Wernli H, Burkhardt JK, Krayenbühl N, Bozinov O, Regli L, Woernle CM. Meteorological influences on the incidence of aneurysmal subarachnoid hemorrhage – a single center study of 511 patients. PLoS One. 2013 Dec 2;8(12):e81621. doi: 10.1371/journal.pone.0081621. eCollection 2013. PubMed PMID: 24312565; PubMed Central PMCID: PMC3847045.

Solter VV, Breitenfeld T, Roje-Bedeković M, Supanc V, Lovrencić-Huzjan A, Serić V, Antoncić I, Basić S, Beros V, Bielen I, Soldo SB, Kadojić D, Lusić I, Maldini B, Marović A, Paladino J, Poljaković Z, Radanović B, Rados M, Rotim K, Vukić M, Zadravec D, Kes VB. General recommendations for the management of aneurysmal subarachnoid hemorrhage. Acta Clin Croat. 2014 Mar;53(1):139-52. PubMed PMID: 24974676.

Solter VV, Roje-Bedeković M, Breitenfeld T, Supanc V, Lovrencić-Huzjan A, Serić V, Antoncić I, Basić S, Beros V, Bielen I, Soldo SB, Kadojić D, Lusić I, Maldini B, Marović A, Paladino J, Poljaković Z, Radanović B, Rados M, Rotim K, Vukić M, Zadravec D, Kes VB. Recommendations for the management of medical complications in patients following aneurysmal subarachnoid hemorrhage. Acta Clin Croat. 2014 Mar;53(1):113-38. PubMed PMID: 24974675.

Lagares A, Munarriz PM, Ibáñez J, Arikán F, Sarabia R, Morera J, Gabarrós A, Horcajadas Á; el Grupo de Patología Vascular de la SENEC. [Variability in the management of aneurysmal subarachnoid haemorrhage in Spain: Analysis of the prospective multicenter database from the Working Group on Neurovascular Diseases of the Spanish Society of Neurosurgery.]. Neurocirugia (Astur). 2015 Jan 15. pii: S1130-1473(14)00153-5. doi: 10.1016/j.neucir.2014.11.005. [Epub ahead of print] Spanish. PubMed PMID: 25599868.

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