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We studied the yield of MRI of the spinal neuraxis in patients with nonperimesencephalic subarachnoid hemorrhage (NPSAH).

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It is uncertain whether familial occurrence of brain arteriovenous malformations (BAVMs) represents coincidental aggregation or a shared familial risk factor. We aimed to compare the prevalence of BAVMs in first-degree relatives (FDRs) of patients with BAVM and the prevalence in the general population.

We investigated whether risk alleles of single nucleotide polymorphisms associated with intracranial aneurysm (IA) are enriched in patients with familial IA, IA located at the middle cerebral artery (MCA), or IA rupture at a younger age.

Epidemiological studies show that an unfavorable lipid profile and coronary artery disease (CAD) are risk traits for abdominal aortic aneurysms (AAAs) but not for intracranial aneurysms (IAs), and that hypertension is a main risk trait for IAs but not for AAAs. To evaluate these observations, we investigated single-nucleotide polymorphisms associated with serum lipid levels, hypertension, and CAD and tested their contribution to AAA and IA risk.

To systematically review the literature on female risk factors and risk of SAH.

Worldwide, different scales are used to assess the clinical condition on admission after aneurysmal subarachnoid hemorrhage. In addition to the prognostic value, the inter-rater variability should be taken into account when deciding which scale preferably should be used. We assessed the interobserver agreement of the commonly used World Federation of Neurological Surgeons, the Hunt and Hess, and the Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage scales.

In aneurysms that are adequately occluded 6 months after coiling, the risk of late reopening is largely unknown. We assessed the occurrence of late aneurysm reopening and possible risk factors.

Survivors of aneurysmal subarachnoid hemorrhage (SAH) may have an increased risk of cardiovascular events because of shared risk factors. We compared incidences of vascular diseases, vascular death, and all-cause death after SAH with those in the general population.

Rates of development of de novo intracranial aneurysms and of growth of untreated additional aneurysms are largely unknown. We performed MRA in a large patient cohort with coiled aneurysms at 5-year follow-up.

Intracerebral hematomas (ICHs) often increase in size in the initial hours. It is unknown whether expansion of ICHs after aneurysmal rupture in the acute phase is always a sign of rerupture of the original aneurysm.

To follow up patients with coiled intracranial aneurysms, magnetic resonance angiography (MRA) is a promising noninvasive alternative to current standard intra-arterial digital subtraction angiography (IA-DSA). MRA test results do not always concord with those of IA-DSA, and the impact of discrepancies on health benefits and costs is unknown. We evaluated the cost-effectiveness of follow-up with MRA vs IA-DSA to assess whether in this setting MRA may replace IA-DSA.

The proportion of incompletely occluded aneurysms after coiling varies widely between studies. To assess overall outcome of coiling, we systematically reviewed the literature to determine initial occlusion, reopening, and retreatment rates of coiled aneurysms according to predefined criteria and subgroups.

Previous modeling studies on treatment of unruptured intracranial aneurysms largely disregarded detailed data on treatment risks and omitted several factors that could influence cost-effectiveness. We performed a cost-effectiveness analysis of surgical and endovascular treatment of unruptured aneurysms for different rupture rates and life expectancies, and assessed the influence of excess mortality risks in these persons, de novo development of aneurysms, and utility of awareness of having an untreated aneurysm, and also identified important factors for which data are lacking.

Delayed cerebral infarction (DCI) is an important cause of poor outcome after subarachnoid hemorrhage. Cerebral perfusion is a predictor for DCI. Because acute hydrocephalus may impair cerebral perfusion, we evaluated the predictive value of the extent of acute hydrocephalus on the development of DCI.

We updated our previous review from 1996 on the risk of rupture of unruptured intracranial aneurysms, aiming to include the newly published articles.

Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for acute hydrocephalus.

The fate of patients with subarachnoid haemorrhage, an aneurysmal pattern of haemorrhage on CT and two or more negative angiographies is unknown. We studied the long-term outcome of patients with three negative angiograms (n = 15) and compared the pattern of hemorrhage of these patients with that of patients with perimesencephalic hemorrhage (n = 73). We reviewed the CT scans of all patients and we followed up the patients with three negative angiograms. The mean period of follow up was 65 months; the number of patient years was 81. In five of the 15 patients with an aneurysmal pattern of hemorrhage the CT scan showed a hemorrhage resembling an anterior circulation aneurysm; in the other 10 patients the center of hemorrhage was behind the chiasm but extended too far in anterior or lateral cisterns to meet the criteria of a true perimesencephalic hemorrhage (‘extended perimesencephalic pattern’). During follow up no episodes of proven aneurysmal rupture had occurred. Three patients subsequently had serious vascular events; one patient (with an extended perimesencephalic pattern) died suddenly; two patients with a pattern of hemorrhage suggestive of an anterior circulation aneurysm were left disabled, one from two episodes of cerebral ischemia and another from a spontaneous intracerbral hemorrhage. In contrast to patients with perimesencephalic hemorrhage who have an uneventful clinical course and an excellent outcome, patients with three negative angiograms and an aneurysmal pattern of hemorrhage are still at some risk of vascular complications and poor outcome. Subdivisions according to the center of hemorrhage once the anterior cisterns are involved is not helpful in identifying patients with good or poor outcome.

We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH.

In patients with aneurysmal subarachnoid haemorrhage, short-term antifibrinolytic therapy with tranexamic acid has been shown to reduce the risk of rebleeding. However, whether this treatment improves clinical outcome is unclear. We investigated whether ultra-early, short-term treatment with tranexamic acid improves clinical outcome at 6 months.

Patients with a perimesencephalic nonaneurysmal subarachnoid hemorrhage are not at risk for rebleeding in the initial years after the hemorrhage. Nevertheless, uncertainty remains on the long-term prognosis after perimesencephalic hemorrhage, and former patients are often considered high-risk cases for health insurance or are denied life insurance. We performed a very long-term follow-up study of a large consecutive series of such patients and compared mortality in this cohort with that in the general population.

The proteoglycan versican is an excellent candidate gene for intracranial aneurysms (IAs) because it plays an important role in extracellular matrix assembly and is localized in a previously implicated locus for IAs on chromosome 5q.

Background:Because age and the presence of atherosclerosis are risk factors for the presence of aneurysms, the presence of multiple aneurysms may also increase with age. Familial preponderance is another risk factor for the presence of aneurysms. Familial subarachnoid haemorrhage (SAH) occurs at an earlier age than sporadic SAH, and a higher frequency of multiple aneurysms has been suggested in familial SAH. This may imply that the multiplicity of aneurysms is associated with younger age. We studied the relation between age and the number of aneurysms in patients with SAH. Methods:From our database we selected patients with aneurysmal SAH admitted between 1985 and 1999. Inclusion criteria were: (1) both carotid and vertebral arteries had been visualised; (2) at least one aneurysm was found, and (3) admission within 72 h after onset of symptoms. For the 555 patients included we recorded the age, sex and number of aneurysms. The patients were categorised into patients with a single aneurysm, patients with more than one aneurysm and those with more than two aneurysms. For all categories we calculated the proportion of patients younger than the median age and the differences between these proportions, with corresponding 95% confidence intervals (CI). We also calculated relative risks (RR) of multiple aneurysms for gender and age below the median. Results:485 patients had a single aneurysm, and 70 patients had more than one aneurysm. The proportion of patients younger than the median age (51 years) with one aneurysm was 47.8%, for more than one aneurysm 61.4% (difference 13.6%; 95% CI 1.4–25.8), and for more than two aneurysms 82.6% (difference 34.8%, 95% CI 18.7–50.9). The RR of women for multiple aneurysms was 1.52 (95% CI 0.61–3.77), and that of age below the median 4.86 (95% CI 1.68–14.1). Conclusions:Patients with multiple aneurysms are younger than patients with a single aneurysm. This may suggest that atherosclerotic risk factors are less important than genetic factors in the development of multiple aneurysms.

Anosmia frequently occurs after aneurysmal subarachnoid hemorrhage not only after clipping, but also after endovascular coiling. Thus, at least in part, anosmia is caused by the hemorrhage itself and not only by surgical treatment. However, it is unknown whether anosmia is related to rupture of the aneurysm with sudden increase in intracranial pressure or to the presence of blood in the basal cisterns. Therefore, we studied the prevalence of anosmia in patients with nonaneurysmal perimesencephalic hemorrhage.