title: Searching for subtle features of laxity of connective tissue in patients with ruptured intracranial aneurysms: a pilot study.
abstract: BACKGROUND
  A disruption of the extracellular matrix (ECM) of the intracranial arterial wall is a likely contributing factor in the pathogenesis of intracranial aneurysms. If this is a generalized process, patients with subarachnoid haemorrhage (SAH) may have subtle signs of a general laxity of the connective tissue. We performed a pilot study to assess general laxity in SAH patients and to examine which tests for joint mobility can be best used in these patients.
  
  
  METHODS
  In 59 SAH patients and sex- and age-matched controls we compared: (1) joint mobility (scores of Beighton and Bulbena and the total range of joint motion); (2) skin extensibility, and (3) bone quantity and stiffness. For the analyses we used the independent-samples T test and linear regression with adjustment for possible confounders.
  
  
  RESULTS
  The patients had a higher degree of joint mobility according to the Beighton criteria (total score of 4 in patients vs. 2 in controls, p = 0.001) and the summation of Z scores of active range of motion measurements (0.1 in patients vs. -0.1 in controls, p = 0.0036), and a tendency towards a higher degree of joint mobility according to the Bulbena criteria (total score of 3 in patients vs. 2 in controls, p = 0.097) and the summation of active range of joint motion measurements (1,292 in patients vs. 1,275 in controls, p = 0.13). No differences were found for the other investigated characteristics.
  
  
  CONCLUSIONS
  Our preliminary results suggest that SAH patients have a higher degree of joint mobility than controls. The Beighton score can be best used in our patient population.
authors.affiliation: Department of Neurology, Rudolf Magnus Institute of Neuroscience, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Rob H A
authors.initials: RH
authors.lastname: Wolswijk
authors.forename: Ynte M
authors.initials: YM
authors.lastname: Ruigrok
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Eva H
authors.initials: EH
authors.lastname: Brilstra
authors.forename: Raoul H H
authors.initials: RH
authors.lastname: Engelbert
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D003238:Connective Tissue / Q000473:pathology / Q000503:physiopathology*; D004548:Elasticity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D007596:Joints / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016059:Range of Motion, Articular; D012867:Skin / Q000503:physiopathology*; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014463:Ultrasonography