Familial Intracranial Aneurysms

  • Lee, Jin-Soo (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, In-Sung (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, Kyung-Bum (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Kang, Dong-Ho (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Lee, Chul-Hee (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Hwang, Soo-Hyun (Department of Neurosurgery, Gyeongsang National University School of Medicine)
  • Published : 2008.09.28

Abstract

Objective : Numerous studies have compared the characteristics of familial intracranial aneurysms with those of non-familial aneurysms. To better understand familial subarachnoid hemorrhage (SAH), we studied a series of patients with SAH who had at least one first-degree relative with SAH, and compared our results with those of previous studies. Methods : We identified patients treated for SAH at our hospital between January 1993 and October 2006 and analyzed those patients with one or more first-degree relatives with SAH. We retrospectively collected data from patients with a family history and searched for patients who had relatives with aneurysms or who had been treated at other hospitals for SAH. Results : We identified 12 patients from six families with at least two first-degree relatives with SAH. All patients had affected first-degree relatives; in five families, they were siblings. The mean age at the time of rupture was 49.75 years; in four families, the age difference was within 5 years. In five patients (42%), the aneurysm was located in the middle cerebral artery. Only one patient had an aneurysm in the anterior communicating artery. Conclusion : In agreement with previous studies, our results showed that familial aneurysms, in comparison with non-familiar aneurysms, ruptured at a younger age and smaller size, had a high incidence in the middle cerebral artery, and were underrepresented in the anterior communicating artery. Interestingly, the age at the time of rupture was similar between relatives. Screening should be considered in the fifth or sixth decade for those who have a sibling with SAH.

Keywords

References

  1. Broderick JP, Sauerbeck LR, Foroud T, Huston J, Pankratz N, Meissner I, et al : The familial intracranial aneurysm (FIA) study protocol. BMC Medical Genet 6 : 17, 2005
  2. Bromberg JE, Rinkel GJ, Algra A, Greebe P, van Duyn CM, Hasan D, et al. : Subarachnoid hemorrhage in first and second degree relatives of patients with subarachnoid hemorrhage. BMJ 311 : 288-289, 1995 https://doi.org/10.1136/bmj.311.7000.288
  3. Bromberg JE, Rinkel GJ, Algra a, Limburg M, van Gijn J : Outcome in familial subarachnoid hemorrhage. Stroke 26 : 961-963, 1995 https://doi.org/10.1161/01.STR.26.6.961
  4. Bromberg JE, Rinkel GJ, Algra A, van Duyn CM, Greebe P, Ramos LM, et al : Familial subarachnoid hemorrhage : distinctive features and patterns of inheritance. Ann Neurol 38 : 929-934, 1995 https://doi.org/10.1002/ana.410380614
  5. Chambers WR, Harper BJ Jr, Simpson JR : Familial incidence of congenital aneurysms of cerebral arteries. Report of cases of ruptured aneurysms in father and son. J Am Med Assoc 155 : 358-359, 1954 https://doi.org/10.1001/jama.1954.73690220001007
  6. Hop JW, Rinkel GJ, Algra A, van Gijn J : Case-fatality rates and functional outcome after subarachnoid hemorrhage : a systematic review. Stroke 28 : 660-664, 1997 https://doi.org/10.1161/01.STR.28.3.660
  7. Kasuya H, Onda H, Takeshita M, Hori T, Takakura K : Clinical features of intracranial aneurysms in siblings. Neurosurgery 46 : 1301-1305; discussion 1305-1306, 2000 https://doi.org/10.1097/00006123-200006000-00004
  8. Leblanc R : Familial cerebral aneurysms. Can J Neurol Sci 24 : 191-199, 1997 https://doi.org/10.1017/S031716710002179X
  9. Leblanc R, Worsley KJ, Melanson D, Tampieri D : Angiographic screening and elective surgery of familial cerebral aneurysms : a decision analysis. Neurosurgery 35 : 9-18; discussion 18-19, 1994 https://doi.org/10.1227/00006123-199407000-00002
  10. Lindgaard L, Eskesen V, Gjerris F, Olsen NV : Familial aggregation of intracranial aneurysms in an Inuit patient population in Kalaallit Nunaat (Greenland). Neurosurgery 52 : 357-362; discussion 362- 363, 2003 https://doi.org/10.1227/01.NEU.0000043695.77193.62
  11. Lozano AM, Leblanc R : Familial intracranial aneurysms. J Neurosurg 66 : 522-528, 1987 https://doi.org/10.3171/jns.1987.66.4.0522
  12. Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Haemorrhage (MARS) Study Group : Risk and benefits of screenning for intracranial aneurysms in first-degree relatives of patients with sporadic subarachnoid hemorrhage. N Engl J Med 341 : 1344-1350, 1999 https://doi.org/10.1056/NEJM199910283411803
  13. Park JK, Kim HJ, Chang SJ, Koh SB, Koh SY : Risk factors for hemorrhagic stroke in Wonju, Korea. Yonsei Med J 39 : 229-235, 1998 https://doi.org/10.3349/ymj.1998.39.3.229
  14. Raaymaker TWM, MARS Study Group : Aneurysms in relatives of patients with subarachnoid hemorrhage : frequency and risk factors. Neurology 53 : 982-988, 1999 https://doi.org/10.1212/WNL.53.5.982
  15. Raaymakers TW, Rinkel GJ, Ramos LM : Initial and follow-up screening for aneurysms in families with familial subarachnoid hemorrhage. Neurology 51 : 1125-1130, 1998 https://doi.org/10.1212/WNL.51.4.1125
  16. Rinkel GJ : Intracranial aneurysm screening : indications and advice for practice. Lancet Neurol 4 : 122-128, 2005 https://doi.org/10.1016/S1474-4422(05)00993-2
  17. Ruigrok YM, Rinkel GJ, Algra A, Raaymakers TW, van Gijn J : Characteristics of intracranial aneurysms in patients with familial subarachnoid hemorrhage. Neurology 62 : 891-894, 2004 https://doi.org/10.1212/01.WNL.0000115104.19787.8E
  18. Teasdale GM, Wardlaw JM, White PM, Murray G, Teasdale EM, Easton V : The familial risk of subarachnoid haemorrhage. Brain 128 : 1677-1685, 2005 https://doi.org/10.1093/brain/awh497
  19. ter Berg HW, Dippel DW, Limburg M, Schievink WI, van Gijn J : Familial intracranial aneurysms. A review. Stroke 23 : 1024-1030, 1992 https://doi.org/10.1161/01.STR.23.7.1024
  20. Teunissen LL, Rinkel GJ, Algra A, van Gijn J : Risk factors for subarachnoid hemorrhage. Stroke 27 : 544-549, 1996 https://doi.org/10.1161/01.STR.27.3.544
  21. Wermer MJ, Rinkel GJ, van Gijn J : Repeated screening for intracranial aneurysms in familial subarachnoid hemorrhage. Stroke 34 : 2788-2791, 2003 https://doi.org/10.1161/01.STR.0000099963.27578.75
  22. Wermer MJ, van der Schaaf IC, Van Nunen P, Bossuyt PM, Anderson CS, Rinkel GJ : Psychosocial impact of screening for intracranial aneurysms in relatives with familial subarachnoid hemorrhage. Stroke 36 : 836-840, 2005 https://doi.org/10.1161/01.STR.0000158906.79898.3a
  23. Wills S, Ronkainen A, van der Voet M, Kuivaniemi H, Helin K, Leinonen E, et al : Familial intracranial aneurysm: an analysis of 346 multiplex Finnish families. Stroke 34 : 1370-1374, 2003 https://doi.org/10.1161/01.STR.0000072822.35605.8B