From the Guidelines
Individuals with a family history of brain aneurysms should undergo screening with magnetic resonance angiography (MRA) or computed tomography angiography (CTA) if they have more than two first-degree relatives with subarachnoid hemorrhage (SAH) or intracranial aneurysms, as this may be reasonable according to the American Heart Association guidelines 1. When considering screening for brain aneurysms in individuals with a family history, it's essential to weigh the risks and benefits. The American Heart Association guidelines suggest that noninvasive screening for unruptured intracranial aneurysms in patients with more than two first-degree relatives with SAH or intracranial aneurysms might be reasonable 1. Some key points to consider when screening for brain aneurysms with a family history include:
- The risk of aneurysm development is higher in individuals with a family history, with first-degree relatives having a 3-7 times higher risk than the general population.
- Early detection allows for monitoring of small aneurysms or preventive treatment of larger ones before they rupture, potentially preventing the devastating consequences of subarachnoid hemorrhage.
- The screening frequency may increase with age or if risk factors develop, such as smoking, hypertension, or genetic conditions like polycystic kidney disease.
- MRA or CTA are recommended screening tools, with MRA being a reasonable option for repeated surveillance imaging over a lifetime due to its lower risk of ionizing radiation compared to CTA 1. It's crucial to note that the guidelines do not recommend universal screening for intracranial aneurysms in the general population or in those with only one first-degree relative with an aneurysm 1. However, for individuals with a strong family history, screening may be beneficial in preventing morbidity and mortality associated with brain aneurysms.
From the Research
Screening for Brain Aneurysms with Family History
- Individuals with a family history of aneurysmal subarachnoid haemorrhage (aSAH) are at increased risk of developing intracranial aneurysms 2, 3, 4, 5, 6
- Studies have shown that long-term serial screening for intracranial aneurysms in individuals with a family history of aSAH can be beneficial in detecting aneurysms 2, 3
- Risk factors for aneurysms at first screening include smoking, history of previous aneurysms, and familial history of aneurysms 2
- History of previous aneurysms is a significant risk factor for aneurysms at follow-up screening 2
- Female sex, history of intracranial aneurysms/aneurysmal subarachnoid hemorrhage, and older age are predictors of new intracranial aneurysms at follow-up screening 3
- The yield of long-term screening is substantial even after more than 10 years of follow-up and two initial negative screens 2
- Screening strategies should take into account the natural history of intracranial aneurysms, the risk of treatment, the cost of screening, and the psychosocial impact of finding an aneurysm 4
- Independent predictors of aneurysm detection on MR angiography include female sex, pack-years of cigarette smoking, and duration of hypertension 5
- People with a positive family history of subarachnoid haemorrhage or polycystic kidney disease are potential candidates for screening 6
- Repeated screening might be done, although the optimum interval between screening assessments and the duration of repeated screening is unclear 6