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Characteristics of aneurysmal subarachnoid hemorrhage associated with rheumatic disease

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Abstract

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.

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Acknowledgments

We would like to thank all members who supported the Nagasaki SAH Registry Study and Editage (www.editage.com) for English language editing.

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All authors read and approved the final manuscript. SY drafted and revised the manuscript, participated in the study concept and design, conducted statistical analyses, and analyzed the data. NH participated in the study concept, and made a substantial contribution to revising the manuscript and design, and interpreted the data. SS is a biostatistician who conducted statistical analyses and analyzed the data. MK, YM, TA, and TI collected and managed patients’ data. KS participated in the study concept. TM was a supervisor and participated in the study concept and design.

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Correspondence to Susumu Yamaguchi.

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The authors declare that they have no conflict of interest.

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This cohort study was approved by the ethics committee of the Nagasaki University Hospital (No. 17112012-4). In this retrospectively designed study, we used anonymized patient data; therefore, the requirement for obtaining patients’ informed consent for publication of the data was waived. However, concerning Fig. 1, we obtained the patient’s written informed consent for publication of their images.

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Yamaguchi, S., Horie, N., Sato, S. et al. Characteristics of aneurysmal subarachnoid hemorrhage associated with rheumatic disease. Neurosurg Rev 44, 2611–2618 (2021). https://doi.org/10.1007/s10143-020-01435-8

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