J Korean Neurosurg Soc.  2020 Sep;63(5):607-613. 10.3340/jkns.2020.0128.

Influence of Triggering Events on the Occurrence of Spontaneous Intracranial Hemorrhage : Comparison of Non-Lesional Spontaneous Intraparenchymal Hemorrhage and Aneurysmal Subarachnoid Hemorrhage

• Na JH
• Kim JH
• Kang HI
• Bae IS
• Kim DR
• Moon BG

• KMID: 2506024
• DOI: http://doi.org/10.3340/jkns.2020.0128

Abstract

Objective
: Spontaneous intracranial hemorrhage is a life-threatening disease, and non-lesional spontaneous intraparenchymal hemorrhage (nIPH) and aneurysmal subarachnoid hemorrhage (aSAH) are the leading causes of spontaneous intracranial hemorrhage. Only a few studies have assessed the association between prior physical activity or triggering events and the occurrence of nIPH or aSAH. The purpose of this study is to investigate the role of specific physical activities and triggering events in the occurrence of nIPH and aSAH.
Methods
: We retrospectively reviewed 824 consecutive patients with spontaneous intracranial hemorrhage between January 2010 and December 2018. Among the 824 patients, 132 patients were excluded due to insufficient clinical data and other etiologies of spontaneous intracranial hemorrhage. The medical records of 692 patients were reviewed, and the following parameters were assessed : age, sex, history of hypertension, smoking, history of stroke, use of antiplatelet or anticoagulation agents, season and time of onset, physical activities performed according to the metabolic equivalents, and triggering event at onset. Events that suddenly raised the blood pressure such as sudden postural changes, defecation or urination, sexual intercourse, unexpected emotional stress, sauna bath, and medical examination were defined as triggering events. These clinical data were compared between the nIPH and aSAH groups.
Results
: Both nIPH and aSAH most commonly occurred during non-strenuous physical activity, and there was no significant difference between the two groups (p=0.524). Thirty-two patients (6.6%) in the nIPH group and 39 patients (8.1%) in the aSAH group experienced triggering events at onset, and there was a significant difference between the two groups (p=0.034). The most common triggering events were defecation or urination in both groups.
Conclusion
: Specific physical activity dose no affect the incidence of nIPH and aSAH. The relationship between the occurrence of intracranial hemorrhage and triggering events is higher in aSAH than nIPH.

Keyword

Cerebral hemorrhage; Exercise; Precipitating factors; Subarachnoid hemorrhage

Reference

References

1. An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke. 19:3–10. 2017.

2. Anderson C, Ni Mhurchu C, Scott D, Bennett D, Jamrozik K, Hankey G, et al. Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke. 34:1771–1776. 2003.

3. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke. 34:2060–2065. 2003.

4. Fann JR, Kukull WA, Katon WJ, Longstreth WT Jr. Physical activity and subarachnoid haemorrhage: a population based case-control study. J Neurol Neurosurg Psychiatry. 69:768–772. 2000.

5. Foreman PM, Griessenauer CJ, Selim MH, Searls DE, Safdar A, Kasper EM, et al. Sexual activity as a trigger for intracranial hemorrhage. Acta Neurochir (Wien). 158:189–195. 2016.

6. Hanel RA, Xavier AR, Mohammad Y, Kirmani JF, Yahia AM, Qureshi A. Outcome following intracerebral hemorrhage and subarachnoid hemorrhage. Neurol Res 24Suppl. 1:S58–S62. 2002.

7. Lindbohm JV, Rautalin I, Jousilahti P, Salomaa V, Kaprio J, Korja M. Physical activity associates with subarachnoid hemorrhage risk- a population-based long-term cohort study. Sci Rep. 9:9219. 2019.

8. Masters WH, Johnson VE. Human sexual response. Boston: Little, Brown and Co;1966. p. 273–293.

9. Matsuda M, Watanabe K, Saito A, Matsumura K, Ichikawa M. Circumstances, activities, and events precipitating aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis. 16:25–29. 2007.

10. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of myocardial infarction onset study investigators. N Engl J Med. 329:1677–1683. 1993.

11. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, et al. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology. 28:754–762. 1978.

12. Park HS, Kang MJ, Huh JT. Recent epidemiological trends of stroke. J Korean Neurosurg Soc. 43:16–20. 2008.

13. Passero S, Ciacci G, Reale F. Potential triggering factors of intracerebral hemorrhage. Cerebrovasc Dis. 12:220–227. 2001.

14. Reynolds MR, Willie JT, Zipfel GJ, Dacey RG. Sexual intercourse and cerebral aneurysmal rupture: potential mechanisms and precipitants. J Neurosurg. 114:969–977. 2011.

15. Schievink WI, Karemaker JM, Hageman LM, van der Werf DJ. Circumstances surrounding aneurysmal subarachnoid hemorrhage. Surg Neurol. 32:266–272. 1989.

16. Thrift AG, Donnan GA, McNeil JJ. Reduced risk of intracerebral hemorrhage with dynamic recreational exercise but not with heavy work activity. Stroke. 33:559–564. 2002.

17. Vlak MH, Rinkel GJ, Greebe P, van der Bom JG, Algra A. Trigger factors and their attributable risk for rupture of intracranial aneurysms: a case-crossover study. Stroke. 42:1878–1882. 2011.