Is screening for brain aneurysms recommended?

From the Guidelines

Routine screening for brain aneurysms is not generally recommended for the general population, but it may be considered for high-risk individuals, such as those with a family history of aneurysms or certain genetic conditions, as stated in the most recent guidelines 1. The decision to screen should be individualized based on personal risk factors and made in consultation with a healthcare provider, typically a neurologist or neurosurgeon. Some key points to consider when deciding whether to screen for brain aneurysms include:

• The incidence of aneurysms in the general population, which is approximately 1.8% 1
• The risk of rupture, which is the most important factor in determining the cost-effectiveness of screening 1
• The potential harms of widespread screening, including unnecessary anxiety, additional testing, and interventions for aneurysms that would never have caused problems 1
• The benefits of screening for high-risk individuals, such as those with a family history of aneurysms or certain genetic conditions, as stated in the guidelines 1. For high-risk individuals, screening typically involves non-invasive imaging such as magnetic resonance angiography (MRA) or CT angiography (CTA), usually beginning at age 20-25 and potentially repeated every 5-10 years if initial results are negative. It is essential to weigh the benefits and risks of screening and to consider the individual's personal risk factors and medical history when making a decision about whether to screen for brain aneurysms. The most recent guidelines from the American Heart Association and the American Stroke Association provide recommendations for screening and treatment of unruptured intracranial aneurysms, and these guidelines should be consulted when making decisions about screening and treatment 1. In summary, while routine screening for brain aneurysms is not recommended for the general population, it may be considered for high-risk individuals, and the decision to screen should be individualized based on personal risk factors and made in consultation with a healthcare provider.

From the Research

Screening for Brain Aneurysms

• Screening for brain aneurysms is not universally recommended, but certain groups may benefit from it 2, 3, 4, 5.
• Individuals with a family history of two or more first-degree relatives with intracranial aneurysms or subarachnoid hemorrhage are considered high-risk candidates for screening 2, 3, 4, 5.
• Patients with autosomal dominant polycystic kidney disease (ADPKD) are also at high risk and may benefit from screening 3, 4, 5.
• Screening may be considered for individuals with one first-degree relative with aneurysmal subarachnoid hemorrhage, but the risks and benefits should be discussed beforehand 4, 5.

Benefits and Risks of Screening

• The benefits of screening include the potential to detect and treat unruptured aneurysms before they cause harm 4, 5.
• However, screening also carries risks, such as the detection of incidental findings, the risk of complications from preventive treatment, and anxiety 4, 6.
• The ultimate goal of screening is to increase the number of quality years of life for the screening candidates, and therefore, the benefits and downsides should be carefully weighed 4.

Target Population for Screening

• The target population for screening includes individuals with a high risk of aneurysmal subarachnoid hemorrhage, such as those with a family history of aneurysms or ADPKD 3, 4, 5.
• Other groups, such as individuals with a history of smoking and hypertension, may also be at high risk, but the prevalence of unruptured aneurysms and the efficiency of screening in these groups are not yet known 4.
• Further research is needed to identify additional high-risk groups and to improve the efficiency of screening 4.