Articles: subarachnoid-hemorrhage.
-
Although small unruptured aneurysms rarely rupture, many patients with subarachnoid hemorrhage (SAH) have ruptured small, especially very small intracranial aneurysms (VSIAs; <3 mm) in clinical practice. We aimed to clarify the proportion and clinical features of patients with SAH with ruptured VSIAs. ⋯ Small unruptured aneurysms rarely rupture; however, many patients with SAH have ruptured VSIAs in clinical practice. We observed that VSIA rates among ruptured aneurysms were fairly high. Age, posterior circulation location, and preferable outcome may be important clinical characteristics of ruptured VSIAs.
-
Lifestyle modifications and advances in surgical and endovascular techniques for treating unruptured intracranial aneurysm (UIA) have vastly evolved over the last few decades and may have reduced the incidence of aneurysmal subarachnoid hemorrhage (aSAH). However, the actual impact of these changes on the rates and outcomes of aSAH remain unexplored. Thus, we studied national aSAH admissions and outcome trends and changes of major risk factors over time. ⋯ Despite a downward trend in the annual frequency of hospitalizations for aSAH, inpatient mortality rates for patients undergoing treatment of the ruptured aneurysm have remained unchanged in the United States. Smoking and hypertension are increasingly prevalent among patients with aSAH. Thus, efforts to control these modifiable risk factors must be further strengthened.
-
Methamphetamine (MA) use is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). MA exerts both hemodynamic and inflammatory effects, but whether these manifest with altered intracranial aneurysm (IA) remodeling is unknown. The objective of this study was to compare IA geometric and morphologic features in patients with and without MA detected on urine toxicology (Utox) at presentation. ⋯ Active use of methamphetamine is independently associated with larger AR in patients with ruptured IA. This may indicate hazardous remodeling due to hemodynamic and/or inflammatory changes.