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Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan

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Abstract

Background

A community-based study was conducted to estimate the incidence rates of multiple aneurysms and to investigate the factors related to multiplicity.

Method

The subjects were 291 patients with ruptured saccular aneurysms treated between 1980 and 1998, in Izumo, Japan. There were 403 aneurysms in total, and 78 patients (27%) had multiple aneurysms.

Findings

Both the crude and the age- and sex-adjusted annual incidence rates per 100,000 population for multiple and single aneurysms were five and 14 for all ages, respectively, and were higher in women than in men. The age-specific incidence rates of both multiple and single aneurysms showed a tendency to increase with age. Of the 190 patients who underwent four-vessel studies, 26% (49) had multiple aneurysms. The frequencies of multiple aneurysms in patients with ruptured aneurysms ≥10 and <10 mm in diameter were 41% and 21%, respectively (p = 0.0081). In patients with multiple aneurysms, the number of aneurysms was greater in those with large ruptured aneurysms, and the unruptured aneurysms tended to be larger in patients with large ruptured aneurysms. The size of the ruptured aneurysms was positively associated with multiplicity, whereas hypertension had an inverse association. Age, sex, aneurysm site and risk factors other than hypertension were not predictive.

Conclusions

This study is the first to provide annual incidence rates for multiple aneurysms in a defined population. It appears that multiplicity of aneurysms is associated with larger ruptured aneurysms and that patients with larger ruptured aneurysms have a higher number of aneurysms as well as larger unruptured aneurysms.

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References

  1. Andrews RJ, Spiegel PK (1979) Intracranial aneurysms. Age, sex, blood pressure, and multiplicity in an unselected series of patients. J Neurosurg 51:27–32

    Article  CAS  PubMed  Google Scholar 

  2. Berry RG, Alpers BJ, White JC (1966) The site, structure and frequency of intracranial aneurysms, angiomas and arteriovenous abnormalities. Res Publ Assoc Res Nerv Ment Dis 41:40–72

    CAS  PubMed  Google Scholar 

  3. Chason JL, Hindman WM (1958) Berry aneurysms of the circle of Willis; results of a planned autopsy study. Neurology 8:41–44

    CAS  PubMed  Google Scholar 

  4. Crompton MR (1966) Mechanism of growth and rupture in cerebral berry aneurysms. Br Med J 1:1138–1142

    Article  CAS  PubMed  Google Scholar 

  5. Ellamushi HE, Grieve JP, Jager HR, Kitchen ND (2001) Risk factors for the formation of multiple intracranial aneurysms. J Neurosurg 94:728–732

    Article  CAS  PubMed  Google Scholar 

  6. Freytag E (1966) Fatal rupture of intracranial aneurysms. Survey of 250 medicolegal cases. Arch Pathol 81:418–424

    CAS  PubMed  Google Scholar 

  7. Housepian EM, Pool JL (1958) A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956. J Neuropathol Exp Neurol 17:409–423

    Article  CAS  PubMed  Google Scholar 

  8. Inagawa T (1990) Multiple intracranial aneurysms in elderly patients. Acta Neurochir (Wien) 106:119–126

    Article  CAS  Google Scholar 

  9. Inagawa T (1991) Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien) 108:22–29

    Article  CAS  Google Scholar 

  10. Inagawa T (1997) What are the actual incidence and mortality rates of subarachnoid hemorrhage? Surg Neurol 47:47–53

    Article  CAS  PubMed  Google Scholar 

  11. Inagawa T (2001) Trends in incidence and case fatality rates of aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Stroke 32:1499–1507

    CAS  PubMed  Google Scholar 

  12. Inagawa T (2002) What are the actual incidence and mortality rates of intracerebral hemorrhage? Neurosurg Rev 25:237–246

    Article  PubMed  Google Scholar 

  13. Inagawa T (2005) Risk factors for aneurysmal subarachnoid hemorrhage in patients in Izumo City, Japan. J Neurosurg 102:60–67

    Article  PubMed  Google Scholar 

  14. Inagawa T (2005) Trends in surgical and management outcomes in patients with aneurysmal subarachnoid hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998. Cerebrovasc Dis 19:39–48

    Article  PubMed  Google Scholar 

  15. Inagawa T (2009) Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan. Surg Neurol (in press)

  16. Inagawa T, Hada H, Katoh Y (1992) Unruptured intracranial aneurysms in elderly patients. Surg Neurol 38:364–370

    Article  CAS  PubMed  Google Scholar 

  17. Inagawa T, Hirano A (1990) Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 34:361–365

    Article  CAS  PubMed  Google Scholar 

  18. Inagawa T, Hirano A (1990) Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol 33:117–123

    Article  CAS  PubMed  Google Scholar 

  19. Inagawa T, Ishikawa S, Aoki H, Takahashi M, Yoshimoto H (1988) Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Incidence. Stroke 19:170–175

    CAS  Google Scholar 

  20. Inagawa T, Shibukawa M, Inokuchi F, Tokuda Y, Okada Y, Okada K (2000) Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City. Japan. Part II: management and surgical outcome. J Neurosurg 93:967–975

    CAS  Google Scholar 

  21. Inagawa T, Takahashi M, Aoki H, Ishikawa S, Yoshimoto H (1988) Aneurysmal subarachnoid hemorrhage in Izumo City and Shimane Prefecture of Japan. Outcome. Stroke 19:176–180

    CAS  Google Scholar 

  22. Inagawa T, Takechi A, Yahara K, Saito J, Moritake K, Kobayashi S, Fujii Y, Sugimura C (2000) Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City. Japan. Part I: incidence and seasonal and diurnal variations. J Neurosurg 93:958–966

    CAS  Google Scholar 

  23. Inagawa T, Tokuda Y, Ohbayashi N, Takaya M, Moritake K (1995) Study of aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Stroke 26:761–766

    CAS  PubMed  Google Scholar 

  24. Inagawa T, Yoshimoto H, Aoki H, Ishikawa S, Takahashi M (1988) The incidence and outcome of aneurysmal subarachnoid hemorrhage in relation to the size of the geographic area (in Japanese). Jpn J Stroke 10:334–339

    Google Scholar 

  25. International Study of Unruptured Intracranial Aneurysms Investigators (1996) Factors related to the development and detection of single versus multiple unruptured intracranial aneurysms. Stroke 27:178 Abstract

    Google Scholar 

  26. Iwamoto H, Kiyohara Y, Fujishima M, Kato I, Nakayama K, Sueishi K, Tsuneyoshi M (1999) Prevalence of intracranial saccular aneurysms in a Japanese community based on a consecutive autopsy series during a 30-year observation period. The Hisayama Study. Stroke 30:1390–1395

    CAS  Google Scholar 

  27. Juvela S (2000) Risk factors for multiple intracranial aneurysms. Stroke 31:392–397

    CAS  PubMed  Google Scholar 

  28. Kaminogo M, Yonekura M, Shibata S (2003) Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 34:16–21

    Article  PubMed  Google Scholar 

  29. Kongable GL, Lanzino G, Germanson TP, Truskowski LL, Alves WM, Torner JC, Kassell NF (1996) Gender-related differences in aneurysmal subarachnoid hemorrhage. J Neurosurg 84:43–48

    Article  CAS  PubMed  Google Scholar 

  30. McCaughey WTE (1956) Ruptured intracranial aneurysms. Ulster Med J 25:111–118

    CAS  PubMed  Google Scholar 

  31. McCormick WF (1973) Intracranial arterial aneurysm: a pathologist’s view. Curr Concepts Cererbrovasc Dis Stroke 8:15–19

    Google Scholar 

  32. McCormick WF, Nofzinger JD (1965) Saccular intracranial aneurysms: an autopsy study. J Neurosurg 22:155–159

    Article  CAS  PubMed  Google Scholar 

  33. Menghini VV, Brown RD Jr, Sicks JD, O’Fallon WM, Wiebers DO (2001) Clinical manifestations and survival rates among patients with saccular intracranial aneurysms: population-based study in Olmsted County, Minnesota, 1965 to 1995. Neurosurgery 49:251–258

    Article  CAS  PubMed  Google Scholar 

  34. Nehls DG, Flom RA, Carter LP, Spetzler RF (1985) Multiple intracranial aneurysms: determining the site of rupture. J Neurosurg 63:342–348

    Article  CAS  PubMed  Google Scholar 

  35. Ogungbo B, Gregson B, Mendelow AD (2003) Relation between age and number of aneurysms in patients with subarachnoid haemorrhage. Cerebrovasc Dis 16:454–455

    Article  CAS  PubMed  Google Scholar 

  36. Ohashi Y, Horikoshi T, Sugita M, Yagishita T, Nukui H (2004) Size of cerebral aneurysms and related factors in patients with subarachnoid hemorrhage. Surg Neurol 61:239–247

    Article  PubMed  Google Scholar 

  37. Østergaard JR, Høg E (1985) Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg 63:49–55

    Google Scholar 

  38. Pleizier CM, Ruigrok YM, Rinkel GJ (2002) Relation between age and number of aneurysms in patients with subarachnoid haemorrhage. Cerebrovasc Dis 14:51–53

    Article  PubMed  Google Scholar 

  39. Qureshi AI, Suarez JI, Parekh PD, Sung G, Geocadin R, Bhardwaj A, Tamargo RJ, Ulatowski JA (1998) Risk factors for multiple intracranial aneurysms. Neurosurgery 43:22–27

    Article  CAS  PubMed  Google Scholar 

  40. Qureshi AI, Sung GY, Suri MFK, Straw RN, Guterman LR, Hopkins LN (2000) Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location. Neurosurgery 46:44–50

    Article  CAS  PubMed  Google Scholar 

  41. Rinne J, Hernesniemi J, Puranen M, Saari T (1994) Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery 35:803–808

    Article  CAS  PubMed  Google Scholar 

  42. Schoenberg BS (1983) Calculating confidence intervals for rates and ratios: simplified method utilizing tabular values based on the Poisson distribution. Neuroepidemiology 2:257–265

    Article  Google Scholar 

  43. Stehbens WE (1963) Aneurysms and anatomical variation of cerebral arteries. Arch Pathol 75:45–64

    CAS  PubMed  Google Scholar 

  44. Sugai M, Shoji M (1968) Pathogenesis of so-called congenital aneurysms of the brain. Acta Pathol Jpn 18:139–160

    CAS  PubMed  Google Scholar 

  45. Wilson G, Riggs HE, Rupp C (1954) The pathologic anatomy of ruptured cerebral aneurysms. J Neurosurg 11:128–134

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

I thank Drs. S. Ishikawa, Y. Tokuda, N. Ohbayashi, M. Takaya, K. Moritake, A. Takechi, K. Yahara, J. Saito, S. Kobayashi, Y. Fujii, C. Sugimura, M. Shibukawa, F. Inokuchi, Y. Okada and K. Okada for their participation in the data collection [19–23].

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  1. Department of Neurosurgery, Araki Neurosurgical Hospital, Kogo-Kita 2-8-7, Nishi-Ku, Hiroshima, 733-0821, Japan

    Tetsuji Inagawa

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Correspondence to Tetsuji Inagawa.

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Inagawa, T. Incidence and risk factors for multiple intracranial saccular aneurysms in patients with subarachnoid hemorrhage in Izumo City, Japan. Acta Neurochir 151, 1623–1630 (2009). https://doi.org/10.1007/s00701-009-0479-y

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