Screening for Unruptured Familial Intracranial Aneurysms: Subarachnoid Hemorrhage 2 Years after Angiography Negative for Aneurysms

Abstract

The screening of asymptomatic individuals in families with intracranial aneurysms has been advocated to detect unruptured aneurysms before a major hemorrhage occurs. We report a 39-year-old male member of a large Dutch family, with a documented history of intracranial aneurysms, who suffered a subarachnoid hemorrhage 2 years after cerebral digital subtraction angiography using intravenously administered contrast medium showed no abnormalities. Conventional arteriography demonstrated three intracranial aneurysms measuring 3 × 3 mm. Potential alternative screening procedures are discussed.

Intracranial Aneurysms

“…A possible caveat for screening programs is based on evidence that intracranial aneurysms may develop over a short period (months, weeks, or even days) and either rupture immediately or remain fairly stable without rupturing. 69,88,89 Screening has been suggested for patients at high risk for the development of an aneurysm. The two groups of patients most commonly screened are those with a family history of intracranial aneurysms 31,89,90 and those with autosomal dominant polycystic kidney disease.…”

Familial intracranial aneurysms. A review.

“…A recent case report describes a ruptured familial IA 5 mm in diameter that was not visualized by means of intravenous digital subtraction angiography (IVDSA) 2 years earlier. 24 Some evidence exists that IAs can rapidly increase in size, but they may also enlarge more gradually. Growth and rupture may occur soon after their formation.…”

Repeated Screening for Intracranial Aneurysms in Familial Subarachnoid Hemorrhage

“…Others have reported a member of a family with intracranial aneurysms in whom SAH occurred only 2 years after a negative angiography. 14 These 3 examples show that screening at an interval of 5 years is not sufficient to detect all new familiar aneurysms. In some families, screening may have to be performed at intervals shorter than an arbitrary period of 5 years.…”