Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Rozenfeld, Michael N.; Ansari, Sameer A.; Shaibani, Ali; Russell, Elliott; Mohan, Pradeep; Hurley, Michael C.

doi:10.3174/ajnr.a3437

Cited by 44 publications

(39 citation statements)

References 60 publications

(60 reference statements)

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“…A direct comparison of 3T time-of-flight MRA with 64 channel multi-detector CTA showed that these techniques have comparable sensitivity and specificity for detection of IA and can detect IAs as small as 2–3 mm. 51–53 MRA is, however, the screening method of choice as gadolinium-based contrast agents are not required.…”

Section: Aysmptomatic Intracranial Aneurysmsmentioning

confidence: 99%

“…Rozenfeld and colleagues recommend screening for IA using 3 T time-of-flight MRA in all patients with ADPKD at initial diagnosis, and follow-up MRA imaging at intervals of 2–10 years, depending on patient-specific risk factors including family history of IA or SAH, hypertension, smoking, alcohol abuse, high risk professions or need for major elective surgery with potential haemodynamic instability. 53 Other experts recommend initial screening only in patients with increased risk of IA rupture defined as those with a family history of IA or SAH, a high-risk profession or those undergoing major elective surgery with potential haemodynamic instability. 42 The rationale for the latter, less-stringent screening strategy is that most detected IAs are small with low risk of rupture.…”

Section: Aysmptomatic Intracranial Aneurysmsmentioning

confidence: 99%

“…53 Wiebers and colleagues propose that aneurysms develop rapidly and either rupture soon after or are stabilized by the elastic component of the aneurysm wall and further strengthened by deposition of collagen. 69 When the size of the IA exceeds 10 mm, however, the resulting high wall stress might promote further growth.…”

Section: Aysmptomatic Intracranial Aneurysmsmentioning

confidence: 99%

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Vascular complications in autosomal dominant polycystic kidney disease

2015

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Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Relentless cyst growth substantially enlarges both kidneys and culminates in renal failure. Patients with ADPKD also have vascular abnormalities; intracranial aneurysms (IAs) are found in ~10% of asymptomatic patients during screening and in up to 25% of those with a family history of IA or subarachnoid haemorrhage. As the genes responsible for ADPKD—PKD1 and PKD2—have complex integrative roles in mechanotransduction and intracellular calcium signalling, the molecular basis of IA formation might involve focal haemodynamic conditions exacerbated by hypertension and altered flow sensing. IA rupture results in substantial mortality, morbidity and poor long-term outcomes. In this Review, we focus mainly on strategies for screening, diagnosis and treatment of IAs in patients with ADPKD. Other vascular aneurysms and anomalies—including aneurysms of the aorta and coronary arteries, cervicocephalic and thoracic aortic dissections, aortic root dilatation and cerebral dolichoectasia—are less common in this population, and the available data are insufficient to recommend screening strategies. Treatment decisions should be made with expert consultation and be based on a risk–benefit analysis that takes into account aneurysm location and morphology as well as patient age and comorbidities.

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Section: Aysmptomatic Intracranial Aneurysmsmentioning

confidence: 99%

Section: Aysmptomatic Intracranial Aneurysmsmentioning

confidence: 99%

Section: Aysmptomatic Intracranial Aneurysmsmentioning

confidence: 99%

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Vascular complications in autosomal dominant polycystic kidney disease

2015

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“…IA rupture usually occurs in patients with ADPKD at younger age than in the general population, often in patients with preserved renal function [5] . Morbidity and mortality due to SAH is also greater in ADPKD [35] with a mortality rate of 46% [36] . In the population of patients with ADPKD most common location of ruptured aneurysms is anterior circulation [19] , especially the anterior communicating artery [32] .…”

Section: Intracranial Aneurysmsmentioning

confidence: 99%

Intracranial Manifestations of Autosomal Dominant Polycystic Kidney Disease

Kulesza

Gradzik

Niemczyk

2016

International Journal of Neurology Research

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Autosomal dominant polycystic kidney disease (ADPKD) belongs to the most common genetic disorders, and affects approximately 1 in 1,000 people in the general population. ADPKD is a systemic disease, with multiple extrarenal manifestations, like arterial hypertension, aneurysms, and cysts in solid organs, including liver, pancreas, and spleen. Among intracranial manifestations of ADPKD, the most important are intracranial aneurysms. ADPKD is a well-known risk factor for them. Additionally, arachnoid cysts may be found in some ADPKD patients. Rarely, pineal cysts and choroid plexus cysts are observed in this population. The aim of our paper is to present intracranial manifestations that may be observed in ADPKD.

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“…Some genetic diseases may also be associated with arterial wall abnormalities that may promote the formation of IC aneurysms. Among them, the most frequently encountered is the polycystic kidney disease (PCKD) [13,14]. In this specific population, the relative risk to have intracranial aneurysm is 4.4-fold higher than in the general population [15].…”

Section: Intracranial Aneurysms: Epidemiologymentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage

Clarençon¹,

Sourour²,

Degos³

et al. 2015

Neurovascular Imaging

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Intracranial aneurysms are a non-exceptional disease affecting 1-3 % of the general population. The incidence of aneurysmal subarachnoid hemorrhage (SAH) is about 1/10,000/year. Aneurysmal SAH is a devastating disease leading to death approximately in 50 % of the cases and to neurological sequels in about 25 % of the cases. Management of aneurysmal SAH consists in early exclusion of the aneurysm's sac either by endovascular means or by microsurgical clipping. Intensive care management is of tremendous importance to treat SAH-related complications like hydrocephalus and to prevent delayed complications such as vasospasm. Current perspectives for intracranial aneurysms management consist in a better selection of the unruptured aneurysms to treat, in order to propose a preventive treatment of exclusion before they bleed.

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Should Patients with Autosomal Dominant Polycystic Kidney Disease Be Screened for Cerebral Aneurysms?

Cited by 44 publications

References 60 publications

Vascular complications in autosomal dominant polycystic kidney disease

Vascular complications in autosomal dominant polycystic kidney disease

Intracranial Manifestations of Autosomal Dominant Polycystic Kidney Disease

Aneurysmal Subarachnoid Hemorrhage

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