title: Long-term risk of aneurysmal subarachnoid hemorrhage after a negative aneurysm screen.
abstract: OBJECTIVE
  The objective was to assess the risk of aneurysmal subarachnoid hemorrhage (aSAH) in the initial 15 years after negative aneurysm screening in persons with one first-degree relative with aSAH.
  
  
  METHODS
  From a cohort of first-degree relatives of patients with aSAH who underwent screening between 1995 and 1997 (n = 626), we included those with a negative screening (n = 601). We retrieved all causes of death and sent a questionnaire to screenees who were still alive. If aSAH was reported, we reviewed all medical data. We assessed the incidence of aSAH in this cohort with survival analysis and calculated an incidence ratio by dividing the observed incidence with the age- and sex-adjusted incidence in the general population.
  
  
  RESULTS
  Of the 601 screenees, 3 had aSAH during 8,938 follow-up patient-years (mean 14.9 years). After 15 years, the cumulative incidence was 0.50% (95% confidence interval: 0.00%-1.06%) with an incidence rate of 33.6 per 100,000 person-years; the incidence rate ratio was 1.7 (95% confidence interval: 0.3-5.7).
  
  
  CONCLUSIONS
  In the first 15 years after a negative screening, the risk of aSAH in persons with one first-degree relative with aSAH is not nil, but in the range of that in the general population, or even higher. Whether this finding justifies serial aneurysm screening in this population requires further study.
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Ingeborg
authors: I
authors: Rasing
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands. ij.m.ruigrok@umcutrecht.nl.
authors: Ynte M
authors: YM
authors: Ruigrok
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Paut
authors: P
authors: Greebe
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Birgitta K
authors: BK
authors: Velthuis
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Theo D
authors: TD
authors: Witkamp
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Marieke J H
authors: MJ
authors: Wermer
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Yvo B
authors: YB
authors: Roos
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: W Peter
authors: WP
authors: Vandertop
authors: From the Department of Neurology and Neurosurgery (I.R., Y.M.R., P.G., B.K.V., T.D.W., G.J.E.R.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht; Leids Universitair Medisch Centrum (I.R., M.J.H.W.), Department of Neurology, Leiden; Neurosurgical Centre Amsterdam (Y.B.R., W.P.V.), Academic Medical Centre Amsterdam and VU University Medical Centre, Amsterdam, the Netherlands.
authors: Gabriel J E
authors: GJ
authors: Rinkel
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000639:trends*; D008875:Middle Aged; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*
references: Neurology. 1998 Oct;51(4):1125-30
references: 9781541
references: Lancet. 1997 Feb 8;349(9049):380-4
references: 9033463
references: Stroke. 2003 Dec;34(12):2788-91
references: 14605323
references: Neurology. 2010 May 25;74(21):1671-9
references: 20498435
references: J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1365-72
references: 17470467
references: N Engl J Med. 1999 Oct 28;341(18):1344-50
references: 10536126
references: J Clin Epidemiol. 2009 Dec;62(12):1248-52
references: 19364636
references: Stroke. 2009 Jun;40(6):1952-7
references: 19228834
references: Brain. 2008 Oct;131(Pt 10):2662-5
references: 18819992
references: Lancet Neurol. 2014 Apr;13(4):385-92
references: 24618352