Characteristics of aneurysmal subarachnoid hemorrhage associated with rheumatic disease

Neurosurg Rev. 2021 Oct;44(5):2611-2618. doi: 10.1007/s10143-020-01435-8. Epub 2020 Nov 11.


Spontaneous subarachnoid hemorrhage (SAH) occurs due to intracranial aneurysm rupture in most cases. Rheumatic disease may cause vessel wall inflammation, which can increase the risk of rupture. However, the characteristics of SAH with rheumatic disease are unknown. This study aimed to evaluate SAH features in patients with rheumatic disease. We retrospectively analyzed clinical data of 5066 patients from the Nagasaki SAH Registry Study who had been diagnosed with aneurysmal SAH between 2001 and 2018. We evaluated the SAH characteristics in patients with rheumatic disease using multivariable logistic regression analysis. In total, 102 patients (2.0%, 11 men and 91 women, median age 69.0 [57.0-75.5]) had rheumatic disease. In these patients, univariate logistic regression analysis showed that sex, hypertension, family history of SAH, smoking history, World Federation of Neurosurgical Societies grade on admission, aneurysm size, multiple aneurysms, treatment, and symptomatic spasms were associated with SAH. Multivariable logistic regression analysis showed that characteristics independently associated with SAH in rheumatic disease were female sex (odds ratio [OR] 3.38; 95% confidence interval [CI] 1.81-6.93, P < 0.001), hypertension (OR 0.60; 95% CI 0.40-0.90, P = 0.012), family history of SAH (OR 0.18; 95% CI 0.01-0.80, P = 0.020), small ruptured aneurysms (OR 1.50; 95% CI 1.02-2.24, P = 0.048), and multiple aneurysms (OR 1.69; 95% CI 1.09-2.58, P = 0.021) in comparison with SAH without rheumatic disease. In conclusion, SAH in patients with rheumatic disease was characterized by small multiple aneurysms, regardless of the low incidence of hypertension and family history of SAH.

Keywords: Aneurysm; Hypertension; Rheumatic disease; Small intracranial aneurysm; Subarachnoid hemorrhage.

MeSH terms

  • Aged
  • Aneurysm, Ruptured* / complications
  • Aneurysm, Ruptured* / epidemiology
  • Female
  • Humans
  • Intracranial Aneurysm* / complications
  • Intracranial Aneurysm* / epidemiology
  • Male
  • Retrospective Studies
  • Rheumatic Diseases* / complications
  • Rheumatic Diseases* / epidemiology
  • Risk Factors
  • Subarachnoid Hemorrhage* / complications
  • Subarachnoid Hemorrhage* / epidemiology