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Published on: August 11, 2015
Repeated screening for intracranial aneurysms in familial subarachnoid hemorrhage
Marieke J H Wermer1, Gabriël J E Rinkel, Jan van Gijn
1Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands. m.wermer@neuro.azu.nl
Insights
Repeated screening for intracranial aneurysms in families with a history of subarachnoid hemorrhage (SAH) shows a considerable yield. However, SAH occurring less than five years after a negative screen suggests shorter intervals may be needed.
Area of Science:
- Neurology
- Radiology
- Genetics
Background:
- Familial intracranial aneurysms and subarachnoid hemorrhage (SAH) often warrant screening.
- The optimal frequency and benefit of repeated screening remain unclear.
Purpose of the Study:
- To assess patient compliance and the diagnostic yield of repeated screening for familial intracranial aneurysms.
- To evaluate the effectiveness of a 5-year screening interval.
Main Methods:
- Relatives with a history of familial SAH underwent repeated screening via MR angiography or CT angiography.
- Analysis included compliance rates and aneurysm detection in subgroups with and without prior aneurysms.
Main Results:
- 10 new aneurysms were detected in 9% of screened relatives.
- Relatives with a history of treated aneurysms had a higher detection rate (16%).
- Two cases of SAH occurred within 3 years of a negative screening.
Conclusions:
- Repeated screening for familial intracranial aneurysms every 5 years demonstrates significant value, especially for those with a history of treated aneurysms.
- The occurrence of SAH shortly after a negative screen indicates a need to consider shorter screening intervals.
Background And Purpose:
In families with >or=2 first-degree relatives with subarachnoid hemorrhage (SAH), screening for aneurysms is often recommended. The benefit of repeated screening and the interval at which screening should be performed are unknown. We studied patient compliance and the yield of repeated screening for familial intracranial aneurysms.
Methods:
Relatives with familial SAH screened between 1990 and 1997 were advised to return every 5 years for follow-up screening with MR angiography. If neurosurgical clipping had been performed in the past, screening was done with CT angiography. We analyzed the results for the group as a whole and for the subgroups of relatives with and without previous aneurysms.
Results:
Of 129 relatives who were advised to undergo further screening, 27 did not return, 74 had 1 repeated screening, and 28 had a second repeated screening. We detected 10 new aneurysms in 9 of the 102 screened relatives (9%), 3 of the 19 relatives with previous aneurysms (16%), and 6 of the 83 relatives without previous aneurysms (7%). One of the 9 subjects with a new aneurysm and 1 other relative had an SAH 3 years after a negative screening procedure.
Conclusions:
In persons with familial occurrence of aneurysms, the motivation for repeated screening every 5 years is high and the yield is considerable, particularly in relatives who have been treated for aneurysms in the past. The occurrence of SAH <5 years after a negative screen suggests that screening may have to be repeated at shorter intervals.
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