Family history of intracranial aneurysms could call for serial screenings

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Those who have a family history of aneurysmal subarachnoid hemorrhage (aSAH) will benefit from long-term serial screening, according to a study published in the April 2014 issue of the Lancet Neurology.

Having two or more first-degree relatives who have suffered from an aSAH poses an increased lifetime risk of aneurysms and aSAH in individuals. Lead author A. Stijntje E. Bor, MD, of the University Medical Center Utrecht in the Netherlands, and colleagues investigated the yield of long-term serial screening for intracranial aneurysms in this demographic.

The researchers reviewed screening results from patients with a positive family history of aSAH from April 1993 to 2013. After a negative screening, each patient received a recommendation to contact the medical center after five years. Information such as familial history of ruptured and unruptured intracranial aneurysms, smoking history, hypertension, previous aneurysms, screening dates, and screening results were recorded. Risk factors for positive initial and follow-up screenings were determined.

Aneurysms were observed in 51 of 458 individuals at first screening, 21 of 261 at second screening, seven of 128 at third screening, and three of 63 at fourth screening. The authors determined the following risk factors for aneurysms at first screening: smoking, history of previous aneurysms, and familial history of aneurysms. At follow-up screening, the only risk factor identified was history of previous aneurysms.

Six of the 129 individuals who were screened before the age of 30 had aneurysms. One patient developed an aneurysm that ruptured during a screening interval.

“We have shown that the yield of screening for intracranial aneurysms in individuals with a family history of aSAH remains at about 5% for each follow-up screening in more than 10 years of follow-up, even after several negative screens,” wrote Bor and colleagues.

The researchers advise that screening for familial aSAH should begin around age 18 and continue until the risk of rupture for aneurysms that are left untreated will likely not outweigh the risk of elective aneurysm treatment. “However, such a strategy should be carefully considered, because such an aggressive approach will also increase the financial costs of screening and the number of patients who might have complications from preventive aneurysm treatment,” they concluded.