Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage.
OBJECTIVE
In families with two or more relatives with subarachnoid hemorrhage (SAH), other first-degree relatives have an increased risk of SAH. We studied the presence of unruptured intracranial aneurysms in 125 members of 23 families with familial SAH, defined as two or more affected first-degree relatives, in a cross-sectional design.


METHODS
MR angiography was performed in 116 relatives; CT angiography was performed in the remaining 9 relatives because they had been treated for intracranial aneurysms in the past.


RESULTS
Overall, we found 16 aneurysms in 10 of 125 relatives (8%; 95% CI, 4 to 14%). Of the nine patients with previous surgery for ruptured or unruptured intracranial aneurysms, three had new aneurysms. Two factors were associated with a significantly higher risk of intracranial aneurysms: 1) a history of treatment for ruptured or unruptured intracranial aneurysms (relative risk 5.5; 95% CI, 1.7 to 17.8) and 2) having three or more affected relatives (relative risk 3.3; 95% CI, 1.0 to 10.6). Siblings tended to have a higher risk of intracranial aneurysms than did children of SAH patients, although the difference was not significant.


CONCLUSIONS
Because the yield is high, screening is recommended in first-degree members of families with familial SAH. Repeated screening should be considered in relatives who have been treated for familial intracranial aneurysms.
Department of Neurology, University Hospital Utrecht, The Netherlands. t.w.m.raaymakers@neuro.azu.nl
T W
TW
Raaymakers
G J
GJ
Rinkel
L M
LM
Ramos
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D018810:Magnetic Resonance Angiography; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010375:Pedigree; D012008:Recurrence; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics