British journal of neurosurgery
February 1, 2026 Ā· via Europe PMC
Circumstances and precipitating factors preceding intracranial aneurysm rupture: a systematic review.
Macaranas AR, Li O, Mensah EO, Ogilvy CS.
AI summary ā for doctors, generated from the abstract only
Aneurysmal subarachnoid haemorrhage most often occurred during routine nonstrenuous activity, so exertion does not appear to be the dominant trigger.
What was studied
Systematic review of six studies including 3285 aSAH cases, categorizing the activity before rupture by metabolic equivalents (nonstrenuous MET 1-4 versus strenuous MET 5 or more).
Key findings
- 43.2% of ruptures followed nonstrenuous activities versus 23.5% after strenuous activities.
- Heavy strain (MET 6-8) preceded 8.9% of cases and Valsalva manoeuvres 7.9%.
- Rupture was less frequent after strenuous activity by combined testing.
Clinical relevance
This informs activity advice for patients with unruptured aneurysms, suggesting blanket exercise restriction may have limited basis.
Who should care
Limitations
Case-based activity data lacked denominators of how often people do each activity, so the results cannot show relative risk, and the abstract is truncated at the key p-value.
Avoid strong blanket activity restrictions for patients with unruptured aneurysms, and focus on blood pressure and other modifiable factors.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates ā verify against the original source before acting on it.
Abstract
Purpose of article
The role of immediate precipitating activities in aneurysmal subarachnoid hemorrhage (aSAH) remains unclear, lcontributing to uncertainty regarding activity restriction. This systematic review and meta-analysis examined the relative strain of activities preceding spontaneous aSAH using metabolic equivalents of task (METs).
Materials and methods
A systematic search identified studies reporting activities preceding aSAH (categorised as nonstrenuous, MET 1-4, and strenuous, MET ā„5). Associations between activity category and aSAH occurrence were assessed using chi-squared testing, with Fisher's combined method evaluating overall association. Odds of aSAH were evaluated using sleep or rest (MET 1) as the reference.
Results
Six studies (3,285 aSAH cases) were included. aSAH mostly preceded nonstrenuous activities (43.2%) compared with strenuous activities (23.5%). Heavy strain activities (MET 6-8) , preceded 8.9% of cases ,while Valsalva maneuversaccounted for 7.9%. Fisher's combined method showed aSAH occurred less frequently after strenuous activities (pā<0.001). Compared with sleep or rest, odds of aSAH were comparable or lower across all other activity categories.
Conclusion
Routine nonstrenuous activities most often preceded aSAH, suggesting high physical exertion may not be a dominant immediate trigger of aneurysm rupture. Other factors, including circadian blood pressure fluctuations and impaired autoregulation, may contribute to rupture risk.
DOI
10.1080/02688697.2026.2624033
PMID
41622833
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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