Family History of Brain Aneurysm Increases Risk in Children
Yes, a family history of brain aneurysm significantly increases the risk of aneurysm development in children, with studies showing a 4-fold increase in prevalence among first-degree relatives of patients with intracranial aneurysms. 1
Risk Assessment Based on Family History
Family history represents an important risk factor for intracranial aneurysms, with several key patterns:
- First-degree relatives of individuals with intracranial aneurysms have a 1.9% to 5.9% increased risk of developing aneurysms 1
- Siblings have a higher likelihood of aneurysm detection than children of affected individuals 1
- The risk is particularly elevated when ≥2 family members have a history of subarachnoid hemorrhage (SAH) or unruptured intracranial aneurysm 1
- In families with multiple affected members, screening has identified aneurysms in:
Characteristics of Pediatric Aneurysms
Pediatric aneurysms differ from adult aneurysms in several important ways:
- Symptomatic intracranial aneurysms are relatively uncommon in children, representing only 1.9% of all ruptured aneurysms 1
- Presentation during childhood is biphasic, with symptoms most often occurring before age 2 or after age 10 1
- Compared to adults, children are more likely to have:
- Giant aneurysms
- Posterior circulation involvement
- Less involvement of anterior and posterior communicating arteries 1
- About 5% of children with intracranial aneurysms have multiple aneurysms, compared to up to 20% in adults 1
Risk Factors That Increase Likelihood of Aneurysm
Several factors increase the likelihood of aneurysm detection in children with familial risk:
- Older age
- Female sex
- Cigarette smoking
- History of hypertension
- Higher lipid levels
- Higher fasting glucose
- Family history of polycystic kidney disease
- Family history of SAH or aneurysm in ≥2 relatives 1
Associated Conditions
Certain congenital and hereditary conditions increase the risk of intracranial aneurysm:
- Coarctation of the aorta
- Autosomal-dominant polycystic kidney disease (3-14 fold increased risk)
- Fibromuscular dysplasia
- Ehlers-Danlos syndrome (primarily type IV)
- Marfan syndrome
- Pseudoxanthoma elasticum 1
Screening Recommendations
For children with family history of brain aneurysm:
- Screening becomes more important as the child matures, as most familial aneurysms don't become symptomatic until adolescence or adulthood 1
- MR angiography (MRA) is the preferred screening method for children due to:
- No radiation exposure
- Good sensitivity for detecting aneurysms
- Suitability for repeated surveillance imaging 1
- Screening frequency should be every 1-5 years depending on risk factors 1
- Screening is particularly warranted for children with:
- ≥2 first-degree relatives with history of aneurysmal SAH or unruptured aneurysm
- Additional risk factors (smoking, hypertension) 1
Prevention Strategies
For children with family history of aneurysms, preventive measures include:
- Avoiding tobacco use (which often begins during adolescence)
- Maintaining normal blood pressure
- Adopting healthy dietary habits 1
Important Caveats
- Most children with familial aneurysm risk remain asymptomatic until adulthood 1
- The inheritance pattern of intracranial aneurysms is not clearly defined, though autosomal dominant transmission is suspected to be most common 1
- No single genetic mutation has been identified as the predominant cause of familial aneurysms 1
- Screening should be individualized based on the number of affected family members and presence of additional risk factors