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PubMed2004

Modified Graeb criteria for predicting the post-hemorrhagic hydrocephalus in intraventricular hemorrhage.

OBJECTIVE: To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. METHODS: We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n = 67) and the lower group (n = 64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagnostic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. RESULTS: In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria.

Aged↗

PubMedDate not supplied

Reversal of delayed vasospasm by TS-011 in the dual hemorrhage dog model of subarachnoid hemorrhage.

PURPOSE: Arachidonic acid is avidly metabolized to a potent vasoconstrictor, 20-hydroxyeicosatetraenoic acid (20-HETE), in the cerebral circulation. 20-HETE has been reported to contribute to the acute fall in cerebral blood flow following subarachnoid hemorrhage (SAH), but its role in the development of delayed vasospasm is unknown. The present study examined whether delayed vasospasm is associated with elevations in 20-HETE in CSF in the dual hemorrhage model of SAH in dogs and if blockade of the synthesis of 20-HETE with N-(3-chloro-4-morpholin-4-yl)phenyl-N'-hydroxyimido formamide (TS-011) can reverse delayed vasospasm in this model. MATERIALS AND METHODS: Delayed vasospasm was induced in 22 adult beagle dogs by dual injection of blood (0.5 mL/kg) into the cisterna magna on days 1 and 4. Sequential samples of CSF were collected before intracisternal injections of blood on days 1 and 4 and after the development of delayed vasospasm on day 7. Sequential angiograms were obtained before and after intracisternal injection of blood on days 1 and 4 and before and 1 hour after administration of TS-011 (1 mg/kg IV) on day 7. RESULTS: The dogs consistently developed delayed vasospasm, and the diameter of the basilar artery fell to 68 +/- 3% (n = 15), 3 days after the second intracisternal injection of blood. The levels of 20-HETE in CSF increased from 4 +/- 2 to 39 +/- 16 pg/mL. In 9 dogs with delayed vasospasm, acute blockade of the synthesis of 20-HETE with TS011 (1 mg/kg IV) significantly increased the diameter of the basilar artery by 39%. Chronic administration of TS-011 (1 mg/kg per day) attenuated the development of delayed vasospasm, and the diameter of the basilar artery fell by 17 +/- 1% versus the 33 +/- 3% decrease in diameter seen in control animals 3 days following the second injection of blood into the cisterna magna. CONCLUSIONS: These results indicate that the development of delayed vasospasm in dogs is associated with an increase in 20-HETE levels in CSF, and acute blockade of the synthesis of 20-HETE with TS-011 reverses delayed vasospasm in this model.

Animals↗

PubMed1989

[Hypertensive putaminal hemorrhage with intraventricular hemorrhage--50 clinical cases and 6 pathoanatomy cases].

50 cases of hypertensive putaminal hemorrhage (HPH) complicated by intraventricular hemorrhage (IVH) were studied by the vertical position typing method with comparison between findings CT results and patho-anatomy of 6 cases. HPH with IVH were typed into five types: IV type, 2V type, IV+3V type, 2V+3V type, total V type. Research the relation between the three ways intruding verticle and position of HPH. Study the average of survive period in HPH with IVH and prognosis. The prognosis of IV+3V type is the best and 2V type os the worse.

Adult↗

PubMed1979

[Central serous retinitis or chorioretinitis (retinopathy or chorioretinopathy) and central hemorrhagic chorioretinitis (juvenile disciform macular detachment; focal hemorrhagic chorioiditis, presumed histoplasmosis) (author's transl)].

There are no clinical or etiological connections between central serous and central hemorrhagic chorioretinitis, Serous chorioretinitis is seen mostly in men; full visual acuity is regained in approx. 80% of all cases. It mainly affects subjects aged between 36 and 45. Hemorrhagic chorioretinitis affects both sexes to about the same extent and causes severe impairment of visual acuity. Both forms should be regarded as genuine inflammations (chorioretinitis centralis serosa, chorioretinitis centralis hemorrhagica), not as "pathies". Whereas the hemorrhagica disease is generally thought to be caused by inflammation, the serous form also often shows signs of inflammation such as varying leakages with inflammatory depigmentation and more frequently inflammatory protein increase (exudate) with precipitation on the posterior surface of the retina/anterior surface of the pigment epithelium.

Adult↗

PubMed1966

Hemorrhage during long-term anticoagulant drug therapy. II. Gastrointestinal hemorrhage.

Most of the gastrointestinal hemorrhages occurring during long-term anticoagulant drug therapy of 2,013 patients (reported in the literature) were caused by underlying lesions (44 to 77). Of the 44 lesions, only seven were diagnosed before treatment was started. Most of the episodes of hemorrhage occurred with the prothrombin activity at a so-called "safe" level. Closer investigation before the anticoagulant therapy was begun might have brought the underlying lesion to light.

Anticoagulants↗

PubMed1984

Alveolar hemorrhage syndromes: diffuse microvascular lung hemorrhage in immune and idiopathic disorders.

We have reviewed the alveolar hemorrhage (AH) syndromes, defined as immune or idiopathic disorders associated with diffuse microvascular hemorrhage into the acinar portion of the lung. The disorders that are most often associated with AH include antibasement membrane antibodies (ABMA) disease, idiopathic pulmonary hemosiderosis, systemic lupus erythematosus, systemic vasculitides, and idiopathic rapidly progressive glomerulonephritis. An approach to the recognition, diagnosis, and treatment of the AH syndromes has been outlined and several illustrative case studies have been presented. Recognition of AH is not usually difficult, but does require a high index of suspicion, since many disease processes may give rise to hemoptysis with infiltrates on chest roentgenogram. Recognition of AH is aided by careful clinical and laboratory assessment for evidence of extrapulmonary disease; simple hematologic studies such as sequential hemoglobins and iron studies; and measurement of carbon monoxide uptake by the lungs. Early recognition of AH may decrease the likelihood of respiratory failure and end-stage renal disease. The specific etiology of AH is usually determined by clinical examination, serologic assay for ABMA, and percutaneous renal biopsy by immunofluorescence. Open-lung biopsy is required in a minority of cases. High-dose pulse methylprednisolone appears to effectively control AH of diverse etiology. Combined plasma exchange and immunosuppression controls AH in ABMA disease and is the treatment of choice in this disorder. Cyclophosphamide is used for Wegener's granulomatosis, and sometimes in systemic necrotizing vasculitis, in an attempt to prevent irreversible damage to the kidneys.

Adult↗

PubMed1980

[Neuropathological study of adult intracranial hemorrhage. III. Analysis of 107 meningeal hemorrhages due to rupture of arterial aneurysms].

The findings in 107 pathological studies of meningeal hemorrhages due to rupture of arterial saccular aneurysms are reported. There were 62 women (58 p. 100) and 45 men (42 p. 100). Mean age was 56, lower in men (53) than in women (58). 45 aneurysms of the Anterior Communicating Artery, 26 of the Middle Cerebral Artery, 15 of the Internal Carotid Artery, 10 of the Anterior Cerebral Artery, 1 of the Anterior Choroidal Artery and 10 of the Posterior System were studied. These ruptured aneurysms were compared to 31 non ruptured ones. Mean size of the ruptured aneurysms was 10, 62 mm, not statistically different from that of non ruptured aneurysms (9, 05 mm). Multiple aneurysms represent 10 p. 100 of the whole ruptured aneurysms population. They affected mostly the Middle Cerebral Artery. High blood pressure had been present in 56/107 cases of ruptured aneurysms (52 p. 100). The prevalence of high blood pressure in patients with ruptured aneurysms (men: 60 p. 100 between 35 and 49, 63 p. 100 between 50 and 64; women: 31 p. 100 between 35 and 49, 54 p. 100 between 50 and 64) was statistically higher than in the same age and sex ranges of the general French population. The other causes of bleeding were rare: 4 liver cirrhosis (2 of the patients were also hypertensive) and 5 anticoagulant therapies (2 of which were also associated with high blood pressure). Intracerebral hematomas were found in 43 cases (40 p. 100): 39 lobar, more frequent in the frontal (26) than in the temporal (13) lobes, due mainly to Anterior Communicating Artery and Anterior Cerebral Artery aneurysms; very few were in the basal ganglia (3) or brainstem (I). Intraventricular hemorrhage was found in 39 cases (36 p. 100). Forty (37 p. 100) cerebral infarcts had occurred. They were located in the territory of the same artery in 20 cases (19 p. 100), in a different territory in 11 cases (10 p. 100), in both in 9 cases (8. p. 100).

Adult↗

PubMedDate not supplied

[Role of the blood kinin system in the pathogenesis of the hemorrhagic syndrome in hemorrhagic vasculitis].

Total esterase activity of blood plasma from healthy persons was equal to 27.4 +/- 4.96 micrometer/ml/hr, activity of kallikrein--74.4 +/- 8.65 micrometer of hydrolysed substrate/hr/ml of blood plasma, inhibitory capacity of blood plasma towards kallikrein was 0.9 +/- 0.1 app. un. Total esterase activity of blood plasma, reflecting the activity of trypsin-like enzymes and kallikrein, was distinctly increased in patients with hemorrhagic vasculitis as compared with control group; content of prekallikrein and the inhibitory capacity of blood plasma towards kallikrein were decreased. In patients with severe forms of hemorrhagic vasculitis the most pronounced activation of blood kinine system was observed due to decrease in content of kallikrein and in the inhibitory capacity of blood plasma towards kallikrein.

Adolescent↗

PubMed1993

Surgical removal of subretinal hemorrhage and choroidal neovascular membranes in acute hemorrhagic age-related macular degeneration.

The visual prognosis in patients with age-related macular degeneration in whom an acute extensive subretinal hemorrhage develops involving the centre of the fovea is extremely poor. We report our results in seven consecutive patients with acute hemorrhagic age-related macular degeneration who underwent pars plana vitrectomy with internal drainage of blood lying beneath the retina and the retinal pigment epithelium. In three of the patients subretinal choroidal neovascular membranes were also removed. Five patients, including three of the four who underwent surgery within 2 weeks of the onset of symptoms, had improved vision following surgery, in one patient choroidal neovascularization recurred, and one patient experienced no change in vision. The best results were obtained in the four patients who did not undergo deliberate dissection of choroidal neovascular membranes.

Acute Disease↗

PubMed1994

Hemorrhage and hemorrhagic infections in the brain.

Hemorrhage in the brain can be accurately staged using a combination of T1- and T2-weighted MR images. The MR appearance depends on the form of hemoglobin present and on whether hemolysis has occurred. The stages of hemorrhage distinguishable by MR imaging are: hyperacute (less than 1 day, intracellular oxyhemoglobin), acute (1-3 day, intracellular methemoglobin), late subacute (7-14 days, extracellular methemoglobin) and chronic (14+ days, hemosiderin rim).

Adult↗

PubMed1993

[Detection of hemorrhagic fever virus-RNA in renal tissue and peripheral blood in patients with hemorrhagic fever with renal syndrome].

Hemorrhagic fever virus (HFV) RNA in renal tissue and blood samples from 21 patients with epidemic hemorrhagic fever with renal syndrome (HFRS) were examined by either in situ or blot hybridization using digoxigenin labelled HFV-cDNA probe. HFV associated antigen and immune complex (IC) in renal tissue were also investigated simultaneously using immunofluorescence (IF) technique. HFV-RNA was detected in the renal specimen particularly renal tubular in 8/21 HFRS patients mostly of severe type illness. However, the deposition of IC in the renal tissue in this group of patients occurred mainly in the mild type apparently in a different manner of HFV-RNA. We conclude that both the HFV-RNA and immune complexes deposition are contributable to the pathogenesis of renal lesion in HFRS.

Adolescent↗

PubMed1994

[Intracranial hemorrhage and hemostasis. Monitoring patients after intracranial hemorrhage by determination and follow-up of activation products of blood coagulation].

OBJECTIVE: The aim of the study was to improve the detection of small hemorrhages with minimal symptoms and of unruptured aneurysms after a subdural and subarachnoid bleeding by the control of the intravascular hemostatic system. DESIGN: Prospective, open study. SETTING: Neurosurgical intensive care unit of a university hospital. PATIENTS: 44 patients undergoing a cranial trepanation. Patients of group 1 (control n = 11) had an intrasellar hypophysoma, patients of group 2 (n = 12) a chronic subdural hematoma without a previous traumatic incident and patients of group 3 (n = 15) a subarachnoid hemorrhage caused by an intracranial aneurysm. INTERVENTIONS: After cranial trepanation changes of plasmatic hemostasis have been assessed by means of immunologically determined parameters of coagulation. The investigation included blood parameters (hemoglobin, hematocrit, thrombocytes), clotting status (prothrombin time, partial thromboplastin time, thrombin time, fibrinogen, plasminogen, antithrombin III [AT III] activity and proteinase inhibitors), as well as immunological methods such as fibrinopeptide A (FPA), thrombin-antithrombin III (TAT), protein C and factor XIII activity (F XIII activity). RESULTS: In comparison to group 1 (control) a significant difference (p < 0.001) was seen in groups 2 and 3 for thrombin-antithrombin III (TAT), fibrinopeptide A (FPA), protein C, and the antithrombin III activity. Intra- and postoperatively increased TAT levels in groups 2 (16.9 ng/ml) and 3 (21.1 ng/ml) and decreased protein C levels (group 2: 61% and group 3: 58%) demonstrated an intravascular thrombin generation. On account of the elevated FPA levels in groups 2 (6.5 ng/ml) and 3 (5.7 ng/ml) and decreased AT III activity in groups 2 (58%) and 3 (62%), this thrombin generation was only incompletely compensated. Caused by proteolytic thrombin effects, another sign for a thrombin-induced turnover of clotting factors is the significant reduction (p < 0.001) of F XIII activity in groups 2 (40%) and 3 (44%). In comparison to group 1 this significantly reduced F XIII activity in groups 2 and 3 was correlated (r = 0.99) to changes in FPA and TAT plasma levels, an indication of latent chronic clotting activity. No significant difference was found concerning total amount of infusion, intra- and postoperative blood loss and blood parameters. Eight patients (group 2: 5 patients, group 3: 3 patients) showed a rebleeding episode without operative interventions. In these patients increased clotting activity (TAT, FPA, protein C) caused by proteolytic thrombin effects was combined with a factor XIII activity smaller than 40%. CONCLUSION: The results of the recent study indicated that immunologically determined TAT, FPA, protein C, factor XIII and AT III activities might serve to improve management in patients with intracranial bleeding events. In view of these parameters the evaluation of risks for a rebleeding is improved. A decrease of the plasma factor XIII activity under 40% associated with a latent clotting activity induced by a thrombin generation caused a higher risk of rebleeding after an initial intracranial bleeding event. The necessity of substituting factor XIII in such cases should be elucidated to minimize risks of rebleeding.

Aneurysm, Ruptured↗

PubMed1996

[Effects of traumatic subarachnoid hemorrhage on pathological properties in diffuse brain injury: a comparison with aneurysmal subarachnoid hemorrhage].

As a result of recent advances in continuous monitoring equipment, it has been reported that vasospasm (VS) and delayed ischemic neurological deficit (DIND) occur as frequently in traumatic subarachnoid hemorrhage (TSAH) as in subarachnoid hemorrhage due to ruptured intracranial aneurysm (ASAH), and these VS and DIND have been reported to affect the outcome of TSAH adversely in many cases. When we compared TSAH secondary to diffuse brain injury (DBI) with ASAH, however, these two conditions were evidently different from each other in nature. Then we compared laboratory data, clinical course, and outcomes of TSAH associated with DBI with those of ASAH, to determine whether TSAH results in poor outcomes of DBI. On CT scans, patterns of SAH distribution were different from each other, and SAH was detected in 76% of the patients with ASAH on day 4, whereas only 2.0% of the patients with TSAH had detectable SAH on day 3. The incidence rates of detectable SAH in both groups remained significantly different from each other after day 2. The cerebral blood flow (CBF) decreased to around 75% of the normal flow in the acute stage of ASAH, and it decreased further to around 65% in the subacute stage. In TSAH, in contrast, CBF varied widely among the patients. The average CBF decreased to about 70% in the acute stage, and then it increased to around the lower limit of the normal range in the subacute stage. The urinary output and serum concentration of low molecular protein compositions in TSAH were markedly different from those in ASAH. In addition, the contour of a low density area (LDA) in CT scans in the subacute-chronic stage was the same as that of the area supplied by the artery being constricted due to cerebro-vascular spasm in ASAH. In TSAH, in contrast, hardly any LDA had a form that was suggestive of this conjuction, with cerebro-vascular spasm and the incidence rate of LDAs was significantly different from that for ASAH. About 30% of the patients with ASAH had ventricular enlargement, which was diagnosed as normal pressure hydrocephalus by cisternography, in the chronic stage. Surgical shunting was effective for these patients. In TSAH, ventricular enlargement was observed in more than 50% of the patients, but almost none of these patients underwent surgical shunting, because it resulted from cerebral atrophy. Regardless of causes of SAH, the severer SAH was, the more often patients had a poor outcome. The outcome of TSAH was, however, significantly poorer than that of ASAH. When SAH was traumatic, it disappeared by the time VS developed and, in addition, changes in CBF and the form and incidence rate of LDAs were different from those in ASAH. We concluded that, although TSAH is an adverse prognostic factor for DBI, it does not contribute to poor outcomes of DBI by giving rise to DIND caused by VS.

Acute Disease↗

PubMed1996

[Severe pelvic injury with pelvic mass hemorrhage: determining severity of hemorrhage and clinical experience with emergency stabilization].

The blood loss during the acute period after complex pelvic trauma is finally responsible for the high mortality associated with this specific type of injury. Several protocols have been published for optimized management, but up to now comparable data are not available as no exact definitions exist judging the severity of trauma and blood loss. As part of a prospective study 19 patients after unstable pelvic injuries with unstable circulation underwent emergency stabilization by the pelvic C-clamp. Beside standard clinical parameter the initial hemoglobin value was converted into a "blood volume equivalent". 18 of the 19 patients had an injury severity according to group III and IV of the Hannover Polytrauma Score (PTS). Concommitant abdominal injuries were seen in 12 cases (23 injuries), concommitant urological injuries in 12 cases (14 injuries). In 13 cases the pelvis was the major source of bleeding in 9 cases an additional intraabdominal hemorrhage was observed. 11 patients died due to sequelae of their injury, 8 patients survived. Although the initial blood loss was comparable both in the group of the deceased patients and the survivors, a 44% higher subsequent blood substitution (= 10089 ml) was observed in the nonsurvivor group. In conclusion the data proofed that early control of hemorrhage is fundamental for the prognoses after complex pelvic trauma. The estimation of the blood loss may help in indicating aggressive emergency procedures like emergency stabilisation, pelvic clamps, surgical exploration and tamponade. This calculation may be a basis for a more detailed analyses of this devastating injury and judging the benefit of different management protocols.

Blood Loss, Surgical↗

PubMed2000

A novel polyomavirus (goose hemorrhagic polyomavirus) is the agent of hemorrhagic nephritis enteritis of geese.

We have identified the etiological agent of hemorrhagic nephritis enteritis of geese (HNEG), a fatal disease of European geese. HNEG has been recognized in almost all goose breeding areas, with an epizootic pattern, and up to now, the infectious agent has remained unknown. In order to identify the causative agent, infected tissues from HNEG-affected geese were inoculated to 1-day-old goslings, which then developed clinical signs typical of HNEG. Tissue homogenates from these birds were subjected to Freon extraction followed by sucrose density gradient ultracentrifugation. The resulting main band was examined by electron microscopy and consisted of spherical, naked, papovavirus-like particles approximately 45 nm in diameter. The virus was isolated and propagated in goose kidney cell primary culture. Tissue- or culture-purified virus allowed the experimental reproduction of the disease in goslings. Random PCR amplification of viral nucleic acid produced a 1,175-bp fragment which was shown to be associated with field samples collected from geese affected by HNEG on commercial farms in France. Sequence analysis of the PCR product revealed a unique open reading frame, showing 63 to 72% amino acid similarity with the major capsid protein (VP1) of several polyomaviruses. Finally, based on phylogenetic analysis, we conclude that the causative agent of HNEG is closely related to but clearly distinct from other polyomaviruses; we thus have named this newly identified virus Goose hemorrhagic polyomavirus.

Amino Acid Sequence↗

PubMedDate not supplied

Epidemiology of dengue/dengue hemorrhagic fever in Malaysia--a retrospective epidemiological study 1973-1987. Part I: Dengue hemorrhagic fever (DHF).

Dengue hemorrhagic fever (DHF), though endemic in the sixties, emerged as a major public health problem in Malaysia from 1973 onwards. The incidence rate of DHF which was 10.1 per 100,000 in 1973 has fallen down to 1.9 per 100,000 in 1987 with a mean case fatality rate of 6.4 per 100 persons. The Chinese appear to be more prone to DHF with the highest mean morbidity rate of 5.5 per 100,000 and case fatality rate of 6.1%. The incidence of DHF is higher in the males with a higher case fatality rate in females. Male Chinese appear to be mainly affected. The overall age-specific incidence rate is highest in two age groups, viz. 5-9 years and 10-19 years of age with a mean morbidity rate of 4.9 cases per 100,000. The mean age-specific case fatality rate was highest in the 0-4 years age group. Dengue hemorrhagic fever is predominantly an urban disease in Malaysia with a mean incidence rate of 5.3 cases per 100,000 as opposed to 1.2 cases per 100,000 being reported from rural areas. The mean overall incidence of deaths in the urban area is 0.5 compared to 0.1 per 100,000 for rural areas. There is a marked seasonal correlation between DHF cases and rainfall, with a peak in August. While all four serotypes of dengue viruses are found in Malaysia, Den 2 appears to be isolated with greater frequency during all the epidemics.

Adolescent↗

PubMedDate not supplied

Efficacy of avirulent hemorrhagic enteritis virus propagated in turkey leukocyte cultures for vaccination against hemorrhagic enteritis in turkeys.

Avirulent hemorrhagic enteritis virus (HEV-A) propagated in turkey leukocyte cell culture was tested as a vaccine to prevent hemorrhagic enteritis (HE) in turkeys in experimental and field trials. Immunization of turkeys with live HEV-A resulted in protection against a challenge with virulent HEV (HEV-V) as measured by the serological response and the absence of clinical disease and HEV antigen in spleens. In field trials, 19 out of 20 flocks seroconverted within 21 days after vaccination with live HEV-A distributed in the drinking water. The average immune response of the turkeys in these flocks was 96%. Most importantly, neither clinical HE nor other adverse effects caused by HEV-A vaccination were observed in any of the vaccinated flocks. Because maternal antibodies can interfere with the immune response to the vaccine, the optimum time for vaccination was determined. Using an established half-life value of 4.25 days for turkey antibody, and knowing the enzyme-linked immunosorbent assay titer of the maternal antibodies and age of the turkey, the time of vaccination could be calculated taking into account that maternal antibody titers should be lower than 40 to vaccinate the turkeys successfully and induce protection. In vivo tests with HEV-A preparations confirmed the replication of the virus in turkey leukocyte cultures and the potential to pass it in culture. Furthermore, in vivo analysis showed that most infectious virus was associated with preparations of the nonadherent cell population, confirming the results obtained by in vitro analysis. The potency of HEV-A preparations was dependent on the production method and varied from an average of 570 to 8135 doses per ml.

Adenoviridae↗

PubMed2003

Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS).

BACKGROUND AND PURPOSE: Unaccustomed strenuous physical exertion can trigger myocardial infarction, but little is known about the mechanisms precipitating subarachnoid hemorrhage (SAH). METHODS: We identified all cases of first-ever SAH among the combined populations (2.8 million) of 4 urban centers in Australia and New Zealand. Information on the type, time, and intensity of exposures in the 26 hours before the onset of SAH was ascertained by structured interviews. We used the case-crossover technique to assess the risk of SAH associated with transient exposures of moderate to extreme physical exertion, heavy cigarette smoking, and binge alcohol consumption. RESULTS: We registered 432 first-ever cases of SAH (62% women; mean age, 56.5 years). A definite time of onset of SAH was established for 393 patients (91%), and information on the levels of physical activity in the preceding 26 hours was obtained in 338 (78%). Of these patients, 19% engaged in moderate to extreme exertion (>or=5 metabolic equivalents) in the 2 hours before SAH, which was associated with a tripling in the risk of SAH (odds ratio [OR], 2.7; 95% CI, 1.6 to 4.6). There was no evidence of any association between heavy cigarette smoking or binge drinking and risk of SAH in the subsequent 2 hours (OR, 1.1; 95% CI, 0.4 to 3.7; and OR, 0.41; 95% CI, - infinity to 5.3). Habitual exercise did not appear to alter the risk of SAH associated with moderate to extreme exertion. CONCLUSIONS: Moderate to extreme physical exertion tripled the risk of SAH, but there was no association between transient heavy smoking or binge drinking and risk of SAH. These data suggest that heavy physical activity may trigger SAH.

Adult↗