FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 341:1344-1350 October 28, 1999 Number 18 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The first-degree relatives of patients who have subarachnoid hemorrhage from ruptured intracranial aneurysms are themselves at risk for subarachnoid hemorrhage. We studied the benefits and risks of screening for aneurysms in the first-degree relatives of patients with sporadic subarachnoid hemorrhage.

Methods We screened 626 first-degree relatives (parents, siblings, or children) of 160 patients with sporadic subarachnoid hemorrhage, from a prospective series of 193 consecutive index patients. Magnetic resonance angiography was the screening tool, and conventional angiography was used as the reference test in subjects thought to have aneurysms. Six months after elective operation, outcome was assessed by means of the modified Rankin scale of neurologic function. This observational study design was combined with a decision-analysis model to estimate the effectiveness of screening. The efficiency of screening was defined by the number of relatives who needed to be screened in order to prevent one subarachnoid hemorrhage.

Results Aneurysms were found in 25 of 626 first-degree relatives (4.0 percent; 95 percent confidence interval, 2.6 to 5.8 percent). Eighteen underwent surgery, which resulted in a decrease in function in 11 (disabling in 1). Five had medium-sized aneurysms that were 5 to 11 mm in diameter, 11 had small aneurysms that were less than 5 mm, and 2 had both small and medium-sized aneurysms. On average, surgery increased estimated life expectancy by 2.5 years for these 18 subjects (or by 0.9 month per person screened), at the expense of 19 years of decreased function per person. The number of relatives who would need to be screened in order to prevent 1 subarachnoid hemorrhage on a lifetime basis was 149, and 298 would have to be screened in order to prevent 1 fatal subarachnoid hemorrhage.

Conclusions Implementation of a screening program for the first-degree relatives of patients with sporadic subarachnoid hemorrhage does not seem warranted at this time, since the resulting slight increase in life expectancy does not offset the risk of postoperative sequelae.

Source Information

Dr. Raaymakers accepts responsibility for the overall content and integrity of the manuscript.

Address reprint requests to Dr. Dianne Raaymakers at the Department of Neurology, H2.128, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands, or at t.w.m.raaymakers{at}neuro.azu.nl.

Full Text of this Article

Related Letters:

Risks and Benefits of Screening for Intracranial Aneurysms
Speth C. P., Raaymakers T. W.M., Rinkel G. J.E., Bossuyt P. M.M., The Magnetic Resonance Angiography in Relatives of Patients with Subarachnoid Hemorrhage Study Group
Extract | Full Text  
N Engl J Med 2000; 342:739-740, Mar 9, 2000. Correspondence

This article has been cited by other articles:

• Lysack, J. T., Coakley, A. (2008). Asymptomatic unruptured intracranial aneurysms: Approach to screening and treatment. cfp 54: 1535-1538 [Abstract] [Full Text]  
• Bor, A. S. E., Rinkel, G. J. E., Adami, J., Koffijberg, H., Ekbom, A., Buskens, E., Blomqvist, P., Granath, F. (2008). Risk of subarachnoid haemorrhage according to number of affected relatives: a population based case-control study. Brain 131: 2662-2665 [Abstract] [Full Text]  
• Brisman, J. L., Song, J. K., Newell, D. W. (2006). Cerebral aneurysms.. NEJM 355: 928-939 [Full Text]  
• Knoll, G., Cockfield, S., Blydt-Hansen, T., Baran, D., Kiberd, B., Landsberg, D., Rush, D., Cole, E., for The Kidney Transplant Working Group of the Can, (2005). Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ 173: S1-S25 [Full Text]  
• Ruigrok, Y M, Rinkel, G J E, Wijmenga, C, van Gijn, J (2004). Anticipation and phenotype in familial intracranial aneurysms. J. Neurol. Neurosurg. Psychiatry 75: 1436-1442 [Abstract] [Full Text]  
• Roos, Y.B.W.E.M., Pals, G., Struycken, P.M., Rinkel, G.J.E., Limburg, M., Pronk, J.C., van den Berg, J.S.P., Luijten, J.A.F.M., Pearson, P.L., Vermeulen, M., Westerveld, A. (2004). Genome-Wide Linkage in a Large Dutch Consanguineous Family Maps a Locus for Intracranial Aneurysms to Chromosome 2p13. Stroke 35: 2276-2281 [Abstract] [Full Text]  
• Ruigrok, Y.M., Rinkel, G.J.E., Algra, A., Raaymakers, T.W.M., van Gijn, J. (2004). Characteristics of intracranial aneurysms in patients with familial subarachnoid hemorrhage. Neurology 62: 891-894 [Abstract] [Full Text]  
• Wills, S., Ronkainen, A., van der Voet, M., Kuivaniemi, H., Helin, K., Leinonen, E., Frosen, J., Niemela, M., Jaaskelainen, J., Hernesniemi, J., Tromp, G. (2003). Familial Intracranial Aneurysms: An Analysis of 346 Multiplex Finnish Families. Stroke 34: 1370-1374 [Abstract] [Full Text]  
• van Maarle, M C, Stouthard, M E A, Bonsel, G J (2003). Quality of life in a family based genetic cascade screening programme for familial hypercholesterolaemia: a longitudinal study among participants. J. Med. Genet. 40: e3-3 [Full Text]  
• Pirson, Y., Chauveau, D., Torres, V. (2002). Management of Cerebral Aneurysms in Autosomal Dominant Polycystic Kidney Disease. J. Am. Soc. Nephrol. 13: 269-276 [Full Text]  
• Bederson, J. B., Awad, I. A., Wiebers, D. O., Piepgras, D., Haley, E. C. Jr, Brott, T., Hademenos, G., Chyatte, D., Rosenwasser, R., Caroselli, C. (2000). Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association. Stroke 31: 2742-2750 [Full Text]  
• Bederson, J. B., Awad, I. A., Wiebers, D. O., Piepgras, D., Haley, E. C. Jr, Brott, T., Hademenos, G., Chyatte, D., Rosenwasser, R., Caroselli, C. (2000). Recommendations for the Management of Patients With Unruptured Intracranial Aneurysms : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association. Circulation 102: 2300-2308 [Full Text]  
• Speth, C. P., Raaymakers, T. W.M., Rinkel, G. J.E., Bossuyt, P. M.M., The Magnetic Resonance Angiography in Relatives of, (2000). Risks and Benefits of Screening for Intracranial Aneurysms. NEJM 342: 739-740 [Full Text]  
• (2000). Screening for Intracranial Aneurysms in First-Degree Relatives. JWatch Neurology 2000: 1-1 [Full Text]  
• (2000). No Need for Routine Screening of Relatives of SAH Patients. JWatch Emergency Med. 2000: 6-6 [Full Text]  
• (1999). Should We Screen Relatives of Patients with Ruptured Intracranial Aneurysms?. JWatch General 1999: 6-6 [Full Text]