Retrospective analysis of incidental and symptomatic cerebral aneurysms and cerebral vascular malformations in a Mongolian cohort of patients undergoing cerebral imaging between 01/2016 and 12/2017. Identification of risk factors in the Mongolian population for cerebral hemorrhage.
Final Report Abstract
Background and Methods: Cerebral hemorrhage due to rupture of an aneurysm in the brain is a common cause of severe disability or death worldwide. Risk factors are known from population studies in industrialized societies (for example, hypertension or smoking, female sex). However, studies of risk factors in developing countries are scarce. The aim of this project was to identify demographic, medical, lifestyle, and environmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. Using treatment data at the central hospital in the capital city of Ulaanbaator, we also aimed to provide the first-ever estimate of a crude national incidence of aneurysmal subarachnoid hemorrhage. For this purpose, all intracranial digital subtraction angiographies (DSA) of the two-year period 2016-2017 were retrospectively evaluated using a newly introduced Mongolian aneurysm registry as part of the project. During this period, DSA was used as the primary diagnostic imaging modality for acute severe neurological symptoms. During the study period, the central hospital in Ulaanbaator was the only hospital for neurological patients nationwide and included the entire country as its catchment area. Results: The estimated crude annual incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied to the Mongolian population. Hypertension, smoking, or the presence of multiple aneurysms resulted in a higher relative risk of rupture. In contrast, female gender was not associated with higher risk in this national cohort. Men living a traditional nomadic lifestyle may have had a particularly high risk of rupture. Conclusion: Treating an average of over 200 people/year with aneurysmal cerebral hemorrhage imposes a socioeconomic burden on a country like Mongolia, which has little developed medical infrastructure. Future efforts to raise awareness of hypertension and smoking as risk factors among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options, such as endovascular embolization of aneurysms, should also be explored.
Publications
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Risk Factors for Cerebral Aneurysm Rupture in Mongolia. Clinical Neuroradiology, 32(2), 499-506.
Bechstein, Matthias; Gansukh, Amarjargal; Regzengombo, Boldbat; Byambajav, Oyun; Meyer, Lukas; Schönfeld, Michael; Kniep, Helge; Hanning, Uta; Broocks, Gabriel; Gansukh, Tserenchunt & Fiehler, Jens
