Is Thyroid Dysfunction Associated with Unruptured Intracranial Aneurysms? A Population-Based, Nested Case-Control Study from Korea

Patients' Characteristics Associated With Size of Ruptured and Unruptured Intracranial Aneurysms

OBJECTIVE

The size of unruptured intracranial aneurysms (UIA) remains the most crucial risk factor for treatment decisions. On the other side, there is a non-negligible portion of small ruptured IA and large stable UIA. This study aimed to identify the patients' characteristics related to IA size in the context of IA rupture status.

METHODS

A total of 2152 patients, with 1002 being hospitalized for an acute aneurysmal subarachnoid hemorrhage (SAH), were included from our institutional IA database. Different demographic and clinical characteristics of patients and IA were collected. IA size was the study endpoint, assessed as continuous variable in univariate and multivariable linear regression analysis, separately for ruptured (R) IA and UIA.

RESULTS

The mean IA size was 8.3 and 7.3 mm in the UIA and RIA subpopulations, respectively. Higher age (p = 0.003) and baseline blood urea level (p < 0.001) were independently associated with increasing UIA size. In contrast, location at the posterior circulation (p < 0.001), familiar intracranial aneurysms (p < 0.001), serum potassium (p = 0.006), and total serum protein (p = 0.019) were related to smaller UIA size in the multivariate analysis. For RIA, a statistically significant and independent association was detected for location (p = 0.019), history of gastrointestinal diseases (p = 0.042), and levothyroxine intake (p = 0.002).

CONCLUSIONS

Identification of clinical characteristics related to the size of ruptured and unruptured IA allows a more differentiated view on the genesis of RIA and UIA and the value of sack size as a basis for therapeutic decision-making. More research is needed to verify the identified risk factors.

Hormonal influences on cerebral aneurysms: unraveling the complex connections

INTRODUCTION

Intracranial aneurysms (IAs) occur in 3-5% of the general population and are characterized by localized structural deterioration of the arterial wall with loss of internal elastic lamina and disruption of the media. The risk of incidence and rupture of aneurysms depends on age, sex, ethnicity, and other different factors, indicating the influence of genetic and environmental factors. When an aneurysm ruptures, there is an estimated 20% mortality rate, along with an added 30-40% morbidity in survivors. The alterations in hormonal levels can influence IAs, while the rupture of an aneurysm can have various impacts on endocrine pathways and affect their outcome.

AREA COVERED

This review explores the reciprocal relationship between endocrinological changes (estrogen, growth hormone, and thyroid hormones) and IAs, as well as the effects of aneurysm ruptures on endocrine fluctuations.

EXPERT OPINION

Based on the data presented in this paper, we recommend further exploration into the influence of hormones on aneurysm formation and rupture. Additionally, we propose conducting endocrine assessments for patients who have experienced a rupture of IAs. Monitoring hormonal changes in patients with IAs could serve as a potential risk factor for rupture, leading to interventions in the approach to managing IAs.

Complex networks approach to study comorbidities in patients with unruptured intracranial aneurysms

The role of complex network analysis in patients with diagnosis of unruptured intracranial aneurysm is unexplored. The objective of this study is to assess the applicability of this methodology in aneurysm patients. We retrospectively analyze comprehensive unbiased local digital data of a large number of patients treated for any reason between January 2004 and July 2019. We apply an age-cohort approach to a total of 628,831 patients and construct the diagnostic history of each patient-and include the information how old the patient was when diagnosed for the first time with each diagnosis coded according to International Classification of Diseases. For each cohort of age within a 10 year interval and for each gender, we construct a statistically validated comorbidity network and focused on crucial comorbidity links that the aneurysm code has to other disease codes within the whole network. For all cohorts of different age and gender, the analysis shows that 267 diagnose codes have nearest neighbour statistically validated links to unruptured aneurysm ICD code. Among the 267 comorbidities, 204 (76%) were found in patients aged from 40 to 69-years old. Patterns of connectivity with aneurysms were found for smoking, hypertension, chronic obstructive pulmonary disease, dyslipidemia, and mood disorders. A few uncommon connections are also detected in cohorts of female patients. Our study explored the applicability of network analysis and statistical validation in aneurysm observational study.