What are the additional screening recommendations for the sibling of a patient who died unexpectedly at age 27 from a ruptured intracranial aneurysm (cerebral aneurysm)?

From the Guidelines

The brother of a patient who died from a brain aneurysm at age 27 should undergo screening with magnetic resonance angiography (MRA) or computed tomography angiography (CTA) of the brain, as first-degree relatives of individuals who have had aneurysmal subarachnoid hemorrhage have an increased risk of developing aneurysms themselves, with a prevalence ratio indicating an increased risk between 1.9% and 5.9% 1.

Screening Recommendations

• The initial screening should be done promptly, with follow-up screenings typically every 5-7 years if the initial results are negative, as suggested by the American Heart Association guidelines 1.
• If multiple family members have had aneurysms, more frequent screening may be warranted, considering the increased risk of aneurysm occurrence in such families 1.

Modifiable Risk Factors

• The brother should also be counseled about modifiable risk factors that increase aneurysm risk, including:
  • Smoking cessation
  • Blood pressure control
  • Avoiding excessive alcohol consumption

Warning Signs and Genetic Counseling

• Additionally, he should be educated about warning signs of aneurysm rupture, such as sudden severe headache, neck stiffness, nausea/vomiting, and sensitivity to light, which require immediate medical attention.
• Genetic counseling may also be beneficial, as certain genetic conditions like polycystic kidney disease and Ehlers-Danlos syndrome are associated with increased aneurysm risk, with autosomal dominant transmission suspected to be the most common mode of inheritance 1.

Imaging Techniques

• Magnetic resonance angiography (MRA) and computed tomography angiography (CTA) are noninvasive methods used to detect intracranial aneurysms, with similar sensitivity and specificity (90% to 95%) for detecting aneurysms, although conventional cerebral angiography remains the diagnostic imaging test for diagnosing intracranial aneurysms 1.

From the Research

Screening Recommendations for the Brother of a Patient Who Died from a Brain Aneurysm

The brother of a patient who died unexpectedly at age 27 from a brain aneurysm may be at increased risk of developing an intracranial aneurysm due to the family history of the condition.

• The risk of subarachnoid hemorrhage (SAH) is increased in first-degree relatives of SAH patients, with a relative risk of 3.7-6.6 2.
• Studies have found that the most frequent relationship between sufferers of SAH is sibling to sibling 2.
• The Familial Intracranial Aneurysm (FIA) study found that first-degree relatives of those affected with intracranial aneurysm (IA) are at increased risk of suffering an IA, particularly if they are women or have a history of smoking or hypertension 3.
• Screening for intracranial aneurysms in individuals with a positive first-degree family history may be useful, particularly if there are multiple affected family members 4.

Risk Factors for Aneurysm Detection

Several risk factors have been identified for aneurysm detection, including:

• Female sex 3
• Pack-years of cigarette smoking 3, 5
• Duration of hypertension 3
• Initial aneurysm size 5
• Dome/neck ratio 5
• Multilobarity 5
• Location in the posterior circulation 5

Screening Methods

Non-invasive tests such as magnetic resonance angiography (MRA), computed tomographic angiography (CTA), and transcranial Doppler (TCD) have been advocated as alternatives to intra-arterial digital subtraction angiography to screen for aneurysms 2.

• MRA and CTA have a reported sensitivity of 76-98% and specificity of 85-100% 2.
• However, these tests are poorer methods for detecting aneurysms <5 mm in diameter, which account for up to one-third of unruptured aneurysms 2.