Familial Intracranial Aneurysms

872

377

Purpose— The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. Methods— The Writing Group members were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel’s recommendations was weighted by applying the American Heart Association Stroke Council’s Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Results— Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.

Section: Disorders Associated With Intracranial Aneurysmmentioning

confidence: 99%

Management of Stroke in Infants and Children

Roach¹,

Golomb²,

Adams³

et al. 2008

872

377

“…259 Increased use of endovascular techniques, increased awareness of high-risk surgical indications, and the sensitivity of modern brain imaging, including CT and MRI, to identify unruptured aneurysms resulted in more endovascular procedures. 48,52,55,260 Increasing proportions of patients undergoing endovascular procedures have been identified in developed countries. 199,208,231,261 Still, most reports on the endovascular treatment of unruptured aneurysms remain small, single-center series.…”

Section: Endovascular Treatmentmentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

801

352

Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

Section: Discussionmentioning

confidence: 90%

“…6 As in other populations such a preponderance of female patients within families exists 7 this may explain that no effect of sex on the transmission was found in the Finnish. 6 Our observed sex-related clustering within families with ICA may be influenced by female hormone levels, 8 alone or by interaction with genetic risk factors. 9 Because hypertension is a risk factor for both sporadic and familial aSAH 10 and heritability for hypertension through the female line has been described, 11 hypertension might also contribute to the sexrelated clustering.…”

Section: Discussionmentioning

confidence: 90%

Sex-Related Clustering of Intracranial Aneurysms Within Families

Sijtsma

Rinkel

Ruigrok

2015

Background and Purpose— Family history is important risk factor for intracranial aneurysms (ICA), but the pattern of inheritance is unsettled. If ICA within families would cluster according to sex, this may have implications for risk prediction and screening advice within families. We assessed the relationship between the sex of probands and their affected first-degree relatives (FDRs) within families with ICA. Methods— We used data from our prospectively collected database of families with known familial ICA. We calculated relative risks for a female affected proband having a female affected FDR as compared with a male affected proband having female affected FDR with corresponding 95% confidence intervals. Results— We included 148 families with 376 affected FDR. For a female proband the relative risk for having a female affected FDR compared with a male proband having an affected female FDR was 1.2 (95% confidence interval, 1.0–1.6). Conclusions— The clustering of ICA within families is greater in women than in men, with an excess of affected female FDR in female probands. However, because this excess is modest, our findings indicate that sex is not a relevant factor in risk prediction or screening advice in families with ICA.