J Cerebrovasc Endovasc Neurosurg.  2020 Sep;22(3):127-133. 10.7461/jcen.2020.22.3.127.

Clinical analysis of young adult patients with ruptured intracranial aneurysms: a single-center study of 113 consecutive patients

Affiliations
  • 1Department of Neurosurgery, Ajou School of Medicine, Ajou University Hospital, Suwon, Korea

Abstract


Objective
Intracranial aneurysm most frequently occurs in old aged patients; however, aneurysmal subarachnoid hemorrhage (SAH) has been occasionally reported in young adults. This study aimed to compare patients with intracranial aneurysms younger than 40 years with those ≥40 years and investigates the characteristics of their ruptured aneurysm.
Methods
We retrospectively collected the data of 389 patients (103 patients aged 20 to 39 years; 286 patients aged above 40 years) who were treated for ruptured cerebral aneurysms between January 2008 and December 2018 at our institution.
Results
The young adult patients were more often men and were smokers as compared to controls (63.1% vs. 39.2%, 40.5% vs. 36.0%, respectively). The young adult patients showed a tendency for lower Hunt and Hess grade, modified Fisher grade, less postoperative morbidity, and better clinical outcome. Aneurysm ruptures occurred most frequently in the anterior cerebral artery in both groups, but aneurysms ruptures in the internal carotid artery and posterior circulation was infrequent among young adult patients. The aneurysms in young adult patients were more often elongated or irregularly shaped (82.5% vs. 64.0%, respectively) and were significantly smaller (5.9 mm) than that in controls (6.8 mm).
Conclusions
Ruptured aneurysms of young adult patients have unique characteristics with regard to its preponderance in male smoker, elongated or irregular shape and relatively smaller size.

Keyword

Adult; Aneurysm; Ruptured intracranial aneurysm; Subarachnoid hemorrhage

Reference

1. Aarhus M, Helland CA, Wester K. Differences in anatomical distribution, gender, and sidedness between ruptured and unruptured intracranial aneurysms in a defined patient population. Acta Neurochir (Wien). 2009; Dec. 151(12):1569–74.
Article
2. Bonita R, Beaglehole R, North JD. Subarachnoid hemorrhage in New Zealand: an epidemiological study. Stroke. 1983; May–Jun. 14(3):342–7.
Article
3. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999; Apr. 30(4):905–15.
4. Broderick JP, Viscoli CM, Brott T, Kernan WN, Brass LM, Feldmann E, et al. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke. 2003; Jun. 34(6):1375–81.
Article
5. Choi JH, Park HS. The incidence and characteristics of patients with small ruptured aneurysms (<5 mm) in subarachnoid hemorrhage. J Korean Neurosurg Soc. 2017; Jul. 60(4):424–32.
6. Ghods AJ, Lopes D, Chen M. Gender differences in cerebral aneurysm location. Front Neurol. 2012; May. 3:78.
Article
7. Horiuchi T, Tanaka Y, Hongo K, Kobayashi S. Aneurysmal subarachnoid hemorrhage in young adults: a comparison between patients in the third and fourth decades of life. J Neurosurg. 2003; Aug. 99(2):276–9.
Article
8. Hourihan MD, Gates PC, McAllister VL. Subarachnoid hemorrhage in childhood and adolescence. J Neurosurg. 1984; 60(6):1163–6.
Article
9. Ishibashi T, Murayama Y, Saguchi T, Ebara M, Arakawa H, Irie K, et al. Justification of unruptured intracranial aneurysm repair: a single-center experience. AJNR Am J Neuroradiol. 2013; Aug. 34(8):1600–5.
Article
10. Jagadeesan BD, Delgado Almandoz JE, Kadkhodayan Y, Derdeyn CP, Cross DT 3rd, Chicoine MR, et al. Size and anatomic location of ruptured intracranial aneurysms in patients with single and multiple aneurysms: a retrospective study from a single center. J Neurointerv Surg. 2014; Apr. 6(3):169–74.
Article
11. Juvela S, Hillbom M, Numminen H, Koskinen P. Cigarette smoking and alcohol consumption as risk factors for aneurysmal subarachnoid hemorrhage. Stroke. 1993; May. 24(5):639–46.
Article
12. Kamitani H, Masuzawa H, Kanazawa I, Kubo T. Saccular cerebral aneurysms in young adults. Surg Neurol. 2000; Jul. 54(1):59–66. discussion 66–7.
Article
13. Kongable GL, Lanzino G, Germanson TP, Truskowski LL, Alves WM, Torner JC, et al. Gender-related differences in aneurysmal subarachnoid hemorrhage. J Neurosurg. 1996; Jan. 84(1):43–8.
Article
14. Lee GJ, Eom KS, Lee C, Kim DW, Kang SD. Rupture of very small intracranial aneurysms: incidence and clinical characteristics. J Cerebrovasc Endovasc Neurosurg. 2015; Sep. 17(3):217–22.
Article
15. Lindekleiv HM, Valen-Sendstad K, Morgan MK, Mardal KA, Faulder K, Magnus JH, et al. Sex differences in intracranial arterial bifurcations. Gend Med. 2010; Apr. 7(2):149–55.
Article
16. Lindgren AE, Koivisto T, Bjorkman J, von Und Zu Fraunberg M, Helin K, Jaaskelainen JE, et al. Irregular shape of intracranial aneurysm indicates rupture risk irrespective of size in a population-based cohort. Stroke. 2016; May. 47(5):1219–26.
Article
17. UCAS Japan Investigators. Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012; Jun. 366(26):2474–82.
Article
18. Ostergaard JR, Voldby B. Intracranial arterial aneurysms in children and adolescents. J Neurosurg. 1983; Jun. 58(6):832–7.
19. Park SK, Kim JM, Kim JH, Cheong JH, Bak KH, Kim CH. Aneurysmal subarachnoid hemorrhage in young adults: a gender comparison study. J Clin Neurosci. 2008; Apr. 15(4):389–92.
Article
20. Pasqualin A, Mazza C, Cavazzani P, Scienza R, DaPian R. Intracranial aneurysms and subarachnoid hemorrhage in children and adolescents. Childs Nerv Syst. 1986; 2(4):185–90.
Article
21. Proust F, Toussaint P, Garnieri J, Hannequin D, Legars D, Houtteville JP, et al. Pediatric cerebral aneurysms. J Neurosurg. 2001; May. 94(5):733–9.
Article
22. Sato K, Yoshimoto Y. Risk profile of intracranial aneurysms: rupture rate is not constant after formation. Stroke. 2011; Dec. 42(12):3376–81.
23. Stirone C, Duckles SP, Krause DN. Multiple forms of estrogen receptor-alpha in cerebral blood vessels: regulation by estrogen. Am J Physiol Endocrinol Metab. 2003; Jan. 284(1):E184–92.
24. Tabuchi S. Relationship between postmenopausal estrogen deficiency and aneurysmal subarachnoid hemorrhage. Behav Neurol. 2015; 2015:720141.
Article
25. Turan N, Heider RA, Zaharieva D, Ahmad FU, Barrow DL, Pradilla G. Sex differences in the formation of intracranial aneurysms and incidence and outcome of subarachnoid hemorrhage: review of experimental and human studies. Transl Stroke Res. 2016; Feb. 7(1):12–9.
Article
26. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003; Jul. 362(9378):103–10.
Article
27. Wojtacha M, Bazowski P, Mandera M, Krawczyk I, Rudnik A. Cerebral aneurysms in childhood. Childs Nerv Syst. 2001; Jan. 17(1–2):37–41.
Article
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