Na Jung Hyun, Kim Jae Hoon, Kang Hee In, Bae In-Suk, Kim Deok Ryeong, Moon Byung Gwan
Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
J Korean Neurosurg Soc. 2020 Sep;63(5):607-613. doi: 10.3340/jkns.2020.0128. Epub 2020 Sep 1.
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.
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.
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.
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.
自发性颅内出血是一种危及生命的疾病，非病灶性自发性脑实质内出血（nIPH）和动脉瘤性蛛网膜下腔出血（aSAH）是自发性颅内出血的主要原因。仅有少数研究评估了既往体力活动或诱发事件与nIPH或aSAH发生之间的关联。本研究的目的是探讨特定体力活动和诱发事件在nIPH和aSAH发生中的作用。
我们回顾性分析了2010年1月至2018年12月期间连续收治的824例自发性颅内出血患者。在这824例患者中，132例因临床资料不足及自发性颅内出血的其他病因被排除。对692例患者的病历进行了回顾，并评估了以下参数：年龄、性别、高血压病史、吸烟史、卒中史、抗血小板或抗凝药物使用情况、发病季节和时间、根据代谢当量进行的体力活动以及发病时的诱发事件。突然升高血压的事件，如突然体位改变、排便或排尿、性交、意外情绪应激、桑拿浴和体检等被定义为诱发事件。对nIPH组和aSAH组的这些临床资料进行了比较。
nIPH和aSAH最常发生在非剧烈体力活动期间，两组之间无显著差异（p = 0.524）。nIPH组32例患者（6.6%）和aSAH组39例患者（8.1%）在发病时经历了诱发事件，两组之间存在显著差异（p = 0.034）。两组中最常见的诱发事件均为排便或排尿。
特定体力活动不影响nIPH和aSAH的发病率。颅内出血与诱发事件之间的关系在aSAH中比在nIPH中更密切。
