ANATOMICAL AND MORPHOLOGICAL FEATURES OF THE MENINGEAL SYNDROME DEVELOPMENT IN CEREBRAL ANEURYSM RUPTURE
DOI:
https://doi.org/10.32782/2226-2008-2024-6-6Keywords:
aneurysmal subarachnoid haemorrhage, meningeal signs, cerebral aneurysmAbstract
Introduction. The prevalence of cerebral aneurysms (CAs) worldwide is approximately 3% of the population. CA rupture accounts for 85% of all subarachnoid haemorrhage cases. One of the clinical manifestations of aneurysmal subarachnoid haemorrhage (aSAH) is neck stiffness caused by an inflammatory response to blood in the subarachnoid space. In fully conscious patients with aSAH and with no focal neurological deficit, meningeal signs may be the only diagnostic indicator. Objective is to assess the anatomical and morphological features of meningeal syndrome development in CA rupture. Materials and methods. The study included 480 medical records of the acute aSAH. There were two groups of patients: Group 1 – patients without meningeal signs, and Group 2 – patients with meningeal signs. Statistical analysis was performed using the χ²-test and binomial logistic regression. Results. Patients with ruptured CA located in the middle cerebral artery (MCA) territory have a threefold higher likelihood of exhibiting meningeal signs compared to those with CA located in the internal carotid artery (ICA) territory (OR=3.29; CI=1.313-8.26; p=0.011). In both groups, the most common locations of ruptured CAs were in the anterior communicating artery territory (34.0% and 40.0%, respectively) and the posterior communicating artery territory (26.3% and 15.9%, respectively). In both groups, the size of ruptured CA between 5 and 9 mm was most frequently observed. An increase in the size of the ruptured CA was associated with a 9.6% decrease in the likelihood of developing meningeal signs (OR=0.904; CI=0.853-0.959; p<0.001). Conclusions. The presence of CA in the MCA territory significantly increases the likelihood of meningeal signs in the acute period of CA rupture compared to CA located in the ICA territory. An increase in the size of the ruptured CA significantly reduces the likelihood of meningeal signs in the acute period of CA rupture.
References
Śliwczyński A, Jewczak M, Dorobek M, et al. An Analysis of the Incidence and Cost of Intracranial Aneurysm and Subarachnoid Haemorrhage Treatment between 2013 and 2021. Int J Environ Res Public Health. 2023; 20(5): 3828. doi: 10.3390/ijerph20053828.
Thilak S, Brown P, Whitehouse T, et al. Diagnosis and management of subarachnoid haemorrhage. Nature Communications. 2024; 15: 1850. doi: 10.1038/s41467-024-46015-2.
Macdonald RL, Schweizer TA. Spontaneous subarachnoid haemorrhage. The Lancet. 2017; 389(10069): 655–666. doi: 10.1016/s0140-6736(16)30668-7.
Ziu E, Khan Suheb MZ, Mesfin FB. Subarachnoid Hemorrhage. StatPearls. Treasure Island (FL). 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441958/.
Van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. The Lancet. 2007; 369(9558): 306–318. doi: 10.1016/s0140-6736(07)60153-6.
Backes D, Rinkel GJЕ, Sturkenboom AJM, Vergouwen MDI. Time-dependent test characteristics of neck stiffness in patients suspected of nontraumatic subarachnoid haemorrhage. Journal of the Neurological Sciences. 2015; 355(1–2): 186–188. doi: 10.1016/j.jns.2015.06.016.
Jaja BNR, Saposnik G, Lingsma HF, et al. Development and validation of outcome prediction models for aneurysmal subarachnoid haemorrhage: the SAHIT multinational cohort study. BMJ. 2018; 360: j5745. doi: 10.1136/bmj.j5745.
Merritt WC, Berns HF, Ducruet AF, et al. Definitions of intracranial aneurysm size and morphology: A call for standardization. Surg Neurol Int. 2021; 12: 506. doi: 10.25259/SNI_576_2021.
Chen J, Liu J, Zhang Y, et al. China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms. Journal of Translational Medicine. 2018; 16(1): 263 doi: 10.1186/s12967-018-1641-1.
Orz Y, AlYamany M. The impact of size and location on rupture of intracranial aneurysms. Asian J Neurosurg. 2015; 10(1): 26–31. doi: 10.4103/1793-5482.144159.
Dolati P, Pittman D, Morrish WF, et al. The Frequency of Subarachnoid Hemorrhage from Very Small Cerebral Aneurysms (< 5 mm): A Population-Based Study. Cureus. 2015; 7(6): е 279 doi: 10.7759/cureus.279.
