Clinical Complications of Hemorrhagic Stroke from Intracranial Aneurysm: An Integrative Review

Emanuel Nascimento Nunes ¹, Jose Vinicius Bulhões Da Silva ², Weslley Barbosa Sales ^3, Eduardo Eriko Tenório de França ⁴, Pollyana Soares de Abreu Morais ⁵, Jose Heriston de Morais Lima ^5*

Understanding hemorrhagic stroke complications from intracranial aneurysms informs better diagnosis, treatment, and prevention strategies to improve patient outcomes.

Abstract

Background: Stroke is a significant alteration in blood flow, often caused by an obstruction or rupture of the arterial vessel wall. Hemorrhagic stroke can result from the rupture of an intracranial aneurysm, characterized by an abnormal dilation of an artery. Understanding the clinical outcomes and complications associated with hemorrhagic strokes resulting from intracranial aneurysms is crucial for improving patient care and outcomes. Methods: This study conducted an integrative literature review using the PRISMA and PICO models. The research question guiding the review was: “What are the clinical complications of stroke resulting from cerebral aneurysm?” Databases searched included PubMed and BVS (LILACS and MEDLINE), using Health Sciences Descriptors (DeCS): (Stroke) AND (Aneurysm) AND (Intracranial hemorrhage) AND (Artery). The Boolean Operator "AND" was used to refine the search. Of the initial 321 articles identified, 27 were selected for full-text review based on title and abstract screening. Ultimately, 15 articles met the inclusion criteria and were included in the final analysis. Results: The review found that aneurysm rupture is a major cause of new stroke cases, accounting for approximately 85% of subarachnoid hemorrhage instances. The majority of these cases occur in males, which may be attributed to lifestyle-related factors such as smoking and dyslipidemia. Clinical manifestations of aneurysmal stroke vary but commonly include severe headaches rated 10/10 on the pain scale. Advanced age is also identified as a significant risk factor. Conclusion: The study concludes that the incidence of hemorrhagic stroke due to aneurysm rupture is higher in males, with major risk factors including advanced age, smoking, and dyslipidemia. Complications from cerebral aneurysms are significantly correlated with the clinical outcomes of hemorrhagic strokes. Understanding these correlations aids in diagnosing and managing probable complications, thereby improving clinical outcomes for patients with hemorrhagic stroke due to intracranial aneurysms.

Keywords: Hemorrhagic stroke, Intracranial aneurysm, Subarachnoid hemorrhage, Clinical outcomes, Risk factors

References

Bai, Q., et al. (2020). Microglia and macrophage phenotypes in intracerebral haemorrhage injury: Therapeutic opportunities. Brain, 143(5), 1297-1314.

Beltrán-Rodríguez, I., et al. (2020). AVC vertebrobasilar: Registro de tempos de atendimento e fatores relacionados ao atendimento precoce. Rev Neurol, 71(9), 326-334.

Brasil. (2018). Aneurisma. Ministério da Saúde.

Bugge, H. F., et al. (2022). Protocolo de estudo paramédico norueguês Acute Stroke Prehospital Project (ParaNASPP): Um ensaio randomizado de cunha escalonada de triagem de acidente vascular cerebral usando a escala de acidente vascular cerebral do National Institutes of Health na ambulância. Trials, 23(1), 113.

Colton, K., et al. (2020). Reconhecimento precoce de acidente vascular cerebral e métricas de desempenho de atendimento de emergência baseadas no tempo para hemorragia intracerebral. J Stroke Cerebrovasc Dis, 29(2).

Gathier, C. S., et al. (2018). Induced hypertension for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: A randomized clinical trial. Stroke, 49(1), 76-83.

Gorelick, P. B. (2019). The global burden of stroke: Persistent and disabling. Lancet Neurology, 18(1), 417-418.

Isaias, L. C. S., et al. (2018). Evolução clínica de pacientes com aneurisma cerebral internados em um hospital público. Revista Interdisciplinar De Estudos Em Saúde, 156-167.

Knight-Greenfield, A., Nario, J. J. Q., & Gupta, A. (2019). Causes of acute stroke: A patterned approach. Radiol Clin North Am, 57(6), 1093-1108.

Kumar, A. M., Das, J., & Mehta, P. (2023). Hemorrhagic stroke. In StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

Lobo, P., et al. (2021). Epidemiologia do acidente vascular cerebral isquêmico no Brasil no ano de 2019, uma análise sob a perspectiva da faixa etária. Brazilian Journals.

Mendes, D., et al. (2018). Characterization of aphasia in aneurysmal subarachnoid hemorrhage. Maranhão. CoDAS, 30(1).

Paliwal, P. R., et al. (2020). Impacto da pandemia de COVID-19 no tratamento de AVC hiperagudo: Experiência de um centro abrangente de AVC em Cingapura. J Thromb Thrombolysis, 50(3), 596-603.

Peng, et al. (2022). Long-term survival, stroke recurrence, and life expectancy after an acute stroke in Australia and New Zealand from 2008–2017: A population-wide cohort study. Stroke.

Shkirkova, K., et al. (2020). Impressão global do paramédico da mudança durante a avaliação pré-hospitalar e transporte para acidente vascular cerebral agudo. AVC, 51(3), 784-791.

Silva, J. V. B., et al. (2024). The amplified effects of Covid-19: Analysis of health risks and global socio-economic conditions. Revista de Gestão Social e Ambiental, 18(4), e07059. https://doi.org/10.24857/rgsa.v18n4-110.