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Screening for familial intracranial aneurysms

BMJ 1999; 319 doi: (Published 11 December 1999) Cite this as: BMJ 1999;319:1512

No justification exists for routine screening

  1. Peter J Kirkpatrick, consultant neurosurgeon,
  2. R S McConnell, senior registrar in neurosurgery
  1. University Department of Neurosurgery, Addenbrooke's Hospital, Cambridge CB2 2QQ

    Familial intracranial aneurysms are those which have been identified in two or more first degree relatives. The relative risk for intracranial aneurysms in such families is about four times that of the general population. 1 2 In the general population the prevalence has been estimated from a meta-analysis to average 2.3% (95% confidence interval 1.7 to 3.1), though the meta-analysis also pointed out the wide variation in prevalence according to method of diagnosis and selection processes.3 In view of the high mortality and morbidity associated with ruptured intracranial aneurysms, screening for unruptured intracranial aneurysms has been suggested, is practised by many, and would at first sight seem a worthwhile goal. Once an aneurysm is discovered, options include treatment or further surveillance to detect growth The recent improved sensitivity of non-invasive magnetic resonance angiography has made screening more practicable. So should we now be seriously considering screening people for familial aneurysms?

    People with familial intracranial aneurysms represent about 5-10% of all patients presenting with an aneurysmal subarachnoid haemorrhage.4 Both genetic and environmental factors have been implicated to explain the clustering of intracranial aneurysms in families. These cases usually bleed at an earlier age and form smaller intracranial aneurysms than those of the general population of people with a subarachnoid haemorrhage, indicating enhanced susceptibility of the vascular wall, whether genetically determined …

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