Are Multiple Intracranial Aneurysms, More Than 5 At One Time, Almost Exclusively A Female Disease? A Clinical Series and Literature Review

Abstract

IntroductionMultiple intracranial aneurysms (MIAs) were first described by Thomson [1] in 1842. Since that time, a female predisposition for the disease has been widely recognized [2][3][4][5][6][7][8][9][10]. Multiple intracranial aneurysms (IAs) occur in approximately one-fourth to one-third of all ruptured and unruptured aneurysm patients. The female to male ratio shows a predisposition for the female gender, with almost exclusively a female predominance when more than 5 aneurysms are present at one time. Risk factors that correlate positively with an increasing number of aneurysms are female gender, smoking, family history of cerebrovascular disease, hypertension, and the postmenopausal state in female patients. As far as location, the most common presentation for multiple IAs in the female group, for both ruptured and unruptured, is the internal carotid artery. The location in males varies to the middle cerebral artery distribution [11]. To our knowledge, this is the first clinical series demonstrating a unique female predisposition when more than 5 aneurysms are present at any one time. MethodsAfter receiving institutional review board approval, a retrospective analysis of patients with complete medical records was performed on 872 patients with 1,438 intracranial aneurysms who were admitted with the diagnosis of MIAs from December 1999 through October 2008. Comorbid conditions were documented, studied, and compared among the genders. Exclusion criteria were: 1) aneurysms located extra-cranially on diagnostic angiography, 2) dissecting or traumatic aneurysms, or 3) aneurysms identified in association with an arteriovenous malformation.We also evaluated patient age, smoking, dyslipidemia, hypertension, alcohol use, rupture status, thyroid function, and past history or family history of an intracranial aneurysm. We compared patients with fewer than three aneurysms with those having three or more aneurysms and those with fewer than AbstractBackground: A large series of intracranial aneurysm patients managed at a high volume Midwest center was analyzed to evaluate the relationship of gender and other factors to aneurysm multiplicity.

Çoklu İntrakraniyal Anevrizmalarda Prognozda Etkili Faktörler

“…In our series, female/male ratio was 2.2/1 with a female dominance similar to the literature (11)(12)(13). Defillo et al reported a 1.39-fold increased incidence of MIA in females (14). In the study of Inagawa including 126 cases, 69% of MIA cases were females (15).…”

Pathogenesis, hemodynamics, and growth of intracranial aneurysms: Future directions

“…A preponderance of intracranial aneurysms occurs in women, which increases with the number of aneurysms (Defillo et al, 2014). In samples of people aged 50 and over, this preponderance may approach a ratio of 1:2, or even greater.…”