From the Guidelines
If your mother had a cerebral aneurysm, you are at a higher risk of developing one, with a recommended screening by CTA or MRA if you have two family members with intracranial aneurysms (IA) or subarachnoid hemorrhage (SAH) 1. The risk factors that predict a particularly high risk of aneurysm occurrence in such families include history of hypertension, smoking, and female sex. Given this information, key points to consider include:
- First-degree relatives (parents, siblings, children) of individuals with cerebral aneurysms have approximately a 2-4 times increased risk compared to those without a family history.
- Your lifetime risk may be around 8-10%, compared to about 3-5% in the general population, due to both genetic factors and potentially shared environmental or lifestyle factors that can contribute to aneurysm formation.
- If you have multiple first-degree relatives with aneurysms, your risk increases further, emphasizing the importance of screening and risk factor management.
- Screening typically involves non-invasive imaging such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA), as recommended for patients with two family members with IA or SAH 1.
- Managing modifiable risk factors is crucial - maintain normal blood pressure, avoid smoking, limit alcohol consumption, and follow a healthy diet and exercise regimen to reduce your overall risk. It is essential to discuss your individual risk and the potential benefits of screening with your healthcare provider, considering your family history and other risk factors such as high blood pressure, smoking, or certain genetic conditions like polycystic kidney disease 1.
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.