8 Triggers and Risk Factors for Aneurysm Identified

There are no clear studies on what activities trigger the rupture of a brain aneurysm. A brain aneurysm results when a weak part of a blood vessel in the brain bulges and fills with blood. The rupture of these aneurysms, due to a sudden increase in blood pressure because of certain triggers, leads to a stroke. This study attempted to identify these triggers. The results revealed that common triggers for rupture of aneurysms are coffee consumption, cola consumption, emotional outbursts and anger, straining for passing stools, sexual intercourse, nose blowing, and strenuous physical exercise. Of these, coffee intake and exercise are the most common triggers.

It is known that nearly 2 percent of the general population has brain aneurysms, and among these, only some cases of brain aneurysm rupture are reported. When a part of a blood vessel having weak walls bulges, the walls are thinned out and are prone to rupture. A rupture leads to paucity of blood supply to an area of the brain, often leading to stroke and paralysis. Being female, old in age, or having high blood pressure raises the risk of rupture of these aneurysms. Furthermore, exercise, sexual intercourse, smoking, alcohol use and emotional upheavals are also known to trigger the rupture of a brain aneurysm. This study attempted to analyze the activities that can trigger the rupture of brain aneurysms.

* The study spanned more than three years during which, 250 patients who had had a brain aneurysm rupture were included in the study.
* All the participants had to answer a questionnaire that asked them if they had experienced any of the 30 potential triggers listed, just before the rupture of their brain aneurysm.
* Risk of rupture from each of the potential triggers was analyzed for the patients, taking into consideration the frequency of the trigger factor before the rupture of the aneurysm.

Key findings
* From this study, eight triggers that can lead to aneurysm rupture were identified.
* Coffee consumption carried a relative risk of 1.7, indicating that the risk of a rupture of brain aneurysm increased 1.7 times after consumption of coffee. The relative risk for other trigger factors were found to be 3.4 for cola consumption, 6.3 for angry outbursts, 23.3 for sudden surprise, 7.3 for straining during defecation, 11.2 for sexual intercourse, 2.4 for nose blowing, and 2.4 for strenuous exercise.
* Coffee consumption and strenuous physical exercise were the most frequent triggers of IA rupture, with coffee consumption being 10.6 percent and physical exercise being 7.9 percent of all the triggers reported.

Next steps/Shortcomings
Authors write that the participants had all suffered from a stroke and they may not have answered the queries correctly. At least one-third of the participants could not answer the questionnaire within two weeks after suffering from stroke. This led to an eventual inclusion of only the ones that recovered fairly. This could have skewed the results of the study and the actual triggers for a serious rupture of aneurysm may have been missed. Further studies that evaluate the measures that can reduce blood pressure and rupture of these blood vessels could be of help.

This study shows that factors like straining, exercise, nose blowing, sexual intercourse etc., which raise the blood pressure, are leading triggers of brain aneurysm rupture causing stroke. Caffeine consumption forms the largest risk factor in the study population. The trigger factors lead to a sudden surge in blood pressure resulting in rupture. Most of these factors are preventable and those having an unruptured aneurysm may be counseled to prevent these triggers for avoiding a rupture in future. Authors add that although physical exercise is a trigger for rupture of an aneurysm, it lowers the risk of heart disease. Therefore, individuals should not refrain from moderate regular physical exercise. Further studies that test the utility of blood pressure lowering drugs in the prevention of aneurysm rupture should be undertaken.

For More Information:
Trigger Factors and Their Attributable Risk for Rupture of Intracranial Aneurysms: A Case-Crossover Study
Publicatin Journal: Stroke, May 2011
By Monique H.M. Vlak, MD; Gabriel J.E. Rinkel, MD, PhD; University Medical Center, Utrecht, the Netherlands

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