Epidemiology, Clinical Pattern and Outcome of Intracranial Aneurysms in Central Iran; A 10-year Experience

Abstract

Background: Intracranial aneurysms are among the most common vascular malformations of the brain being associated with high morbidity and mortality. The epidemiology and clinical pattern of the disease will assist the physicians to encounter the disease more precautiously. The pattern and characteristics of intracranial aneurysms has not been previously described in Iranian population. Thus the aim of the current study is to determine the characteristics of the disease in an Iranian population. Materials and Methods: This was a retrospective cross-sectional study being performed in Al-Zahra and Kashani healthcare centers affiliated with Isfahan University of Medical Sciences during a 10-year period from 2003 to 2013. We included all the patients who presented to our centers with acute subarachnoid hemorrhage and were further diagnosed to have intracranial aneurysms. The patients’ medical charts were reviewed for demographic information, risk factors, the treatment options and the patients’ outcome.Results: Overall we included 447 patients with mean age of 48.1 ± 14.1 (range 13 to 82) years out of whom 210 (47%) were men and 237 (53%) were women. Among the patients, there were 31 (6.9%) Armenian. Spring with 141 (31.5%) patients was the most common season of presentation. Family history of vascular anomalies was reported in 26 (5.9%) patients. Of the patients, 143 (32%) had more than one aneurysms. After the city of Isfahan, the most common place of residence was western parts of the province. World Federation of Neurosurgeons Scale (WFNS) was calculated to be 1 in 169 (37.8%) and 2 in 131 (29.3%) patients. The most common site of the aneurysms was middle cerebral artery in 166 (37.1%) followed by anterior communicating artery in 96 (21.5%). Saccular aneurysms were found to be the most common type of the aneurysm with a frequency of 296 (66.2%). Overall, 412 (92.2%) patients underwent surgical clipping while 37 (8.9%) were expired during the hospital stay. 35 (7.8%) patients died before operation. Infarction was the most common complication of the surgery being reported in 54 (13.1%) followed by neurological deficit in 24 (5.8%). Hypertension was the most common risk factor being recorded in 93 (20.8%). During the hospital stay, 46 (10.3%) developed vasospasm and 22 (4.9%) rebleeding.Conclusion: The clinical pattern as well as outcome of the patients with intracranial aneurysms in Iran is similar to that being previously reported in the international literature. As the mortality rates of these aneurysms is extremely high, screening work-ups especially in those with family history of vascular anomalies is recommended.

 Keywords: Intracranial Aneurysms; Clinical pattern; Mortality rate; Iran