From the Guidelines
If your mother had a cerebral aneurysm, you should be offered aneurysmal screening by CTA or MRA due to your increased risk, especially if you have additional risk factors such as hypertension, smoking, or female sex. The risk of cerebral aneurysm in individuals with a family history is a significant concern, with first-degree relatives having approximately a 2-4 times increased risk compared to those without a family history 1. This translates to a potential lifetime risk of 8-12% for you, compared to the general population's 3-5% risk. According to the guidelines for the management of patients with unruptured intracranial aneurysms by the American Heart Association/American Stroke Association, screening is recommended for patients with 2 family members with IA or SAH, and it is reasonable to offer screening to those with a single first-degree relative with an aneurysm, especially in the presence of other risk factors 1. Key factors that predict a high risk of aneurysm occurrence in families include:
- History of hypertension
- Smoking
- Female sex It is essential to discuss screening with your healthcare provider, particularly if multiple relatives are affected or if aneurysms occurred at a young age. Screening typically involves non-invasive imaging such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA). Additionally, managing modifiable risk factors is crucial, including:
- Avoiding smoking
- Maintaining healthy blood pressure
- Limiting alcohol consumption
- Avoiding illicit drugs like cocaine Regular medical check-ups are also recommended to monitor for any neurological symptoms that could indicate an aneurysm.
From the Research
Risk of Cerebral Aneurysm
- The risk of cerebral aneurysm in individuals with a family history of the condition is a significant concern 2.
- Studies have shown that individuals with a positive first-degree family history of aneurysmal subarachnoid hemorrhage (aSAH) or intracranial aneurysm (IA) have an increased risk of developing IA themselves 2.
- The prevalence of IA in individuals with ≥2 affected first-degree relatives is significantly higher than in the general population, with an average prevalence of 13.1% compared to 3% in the general population 2.
Screening for Cerebral Aneurysms
- Current guidelines recommend screening for IA in families with ≥2 affected first-degree relatives 3, 2.
- However, recent studies suggest that screening may also be beneficial for individuals with only one first-degree relative with IA or aSAH, particularly if they have additional risk factors 2.
- The cost-effectiveness of screening for IA in individuals with a positive first-degree family history is still a topic of debate, but some studies suggest that serial screening over time can be cost-effective in preventing aSAH 2.
Diagnostic Tools
- Digital subtraction angiography (DSA) remains the reference standard for imaging of intracranial aneurysms due to its high spatial and temporal resolution 4.
- Non-invasive imaging technologies such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are also useful for diagnosing IA, and their diagnostic accuracy is increasingly approaching that of DSA 4.
- A system to automatically detect cerebral aneurysms in multimodal 3D angiographic data sets has been developed, which can help radiologists find cerebral aneurysms and reduce the risk of overlooking small aneurysms 5.