title: Corticosteroid use and risk of aneurysmal subarachnoid haemorrhage.
abstract: OBJECTIVE
  Corticosteroids can induce hypertension and inhibit collagen synthesis in the blood vessel wall. Deficiencies in collagen have been found in intracranial aneurysms. Therefore use of corticosteroids could be a risk factor for intracranial aneurysms and aneurysmal subarachnoid haemorrhage (SAH). We investigated the relationship between the systemic use of corticosteroids in the past and the occurrence of aneurysmal SAH.
  
  
  METHODS
  We compared the systemic use of corticosteroids (oral or intravenous) in the past between a consecutive series of 1158 patients with aneurysmal SAH and a control group consisting of 1019 patients diagnosed with a primary central nervous system (CNS) tumour. We discriminated between definite use of corticosteroids defined as use mentioned in the medical record and possible use defined as note in the medical record of a disease that may be treated with corticosteroids. We calculated odds ratios (OR) with corresponding 95% confidence intervals (CI) and adjusted for age and sex by means of logistic regression analyses.
  
  
  RESULTS
  Twenty (1.7%, 95% CI 1.1-2.7) of the SAH patients and eight (0.8%, 95% CI 0.3-1.5) of the controls had used systemic corticosteroids (OR: 2.22; 95% CI 0.97-5.05; p-value 0.058; adjusted OR 2.23; 95 % CI 0.97-5.15; p-value 0.059). For definite plus possible use the OR was 1.67 (95% CI 1.09-2.54; p-value 0.016) and the adjusted OR 1.52 (95% CI 0.99-2.33; p-value 0.055).
  
  
  CONCLUSIONS
  Patients with aneurysmal SAH more often have used systemic corticosteroids in the past than controls. This may suggest that the use of corticosteroids is a risk factor for aneurysmal SAH.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, 85500, 3500 GA, Utrecht, The Netherlands. ij.m.ruigrok@neuro.azu.nl
authors.forename: Y M
authors.initials: YM
authors.lastname: Ruigrok
authors.forename: P J W
authors.initials: PJ
authors.lastname: Dekkers
authors.forename: J E C
authors.initials: JE
authors.lastname: Bromberg
authors.forename: A
authors.initials: A
authors.lastname: Algra
authors.forename: G J E
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000367:Age Factors; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D003094:Collagen / Q000096:biosynthesis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000503:physiopathology; D002532:Intracranial Aneurysm / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D003094:Collagen