Subarachnoid hemorrhage screening

Jump to: navigation, search

Subarachnoid Hemorrhage Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Subarachnoid Hemorrhage from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)

Risk Factors/Prevention
Natural History/Outcome
Clinical Manifestations/Diagnosis
Medical Measures to Prevent Rebleeding
Surgical and Endovascular Methods
Hospital Characteristics/Systems of Care
Anesthetic Management
Cerebral Vasospasm and DCI
Hydrocephalus
Seizures Associated With aSAH
Medical Complications

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Subarachnoid hemorrhage screening On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Subarachnoid hemorrhage screening

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Subarachnoid hemorrhage screening

CDC on Subarachnoid hemorrhage screening

Subarachnoid hemorrhage screening in the news

Blogs on Subarachnoid hemorrhage screening

Directions to Hospitals Treating Subarachnoid hemorrhage

Risk calculators and risk factors for Subarachnoid hemorrhage screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Mehrsefat, M.D. [2]

Overview

First-degree relatives screening is recommend in individuals with a positive family history of subarachnid hemorrhage or cerebral aneurysm in more than two family members.[1][2] However, screening is not recommend in individuals with only one affected first-degree relative.[3] Additionally, screening is recommend in the patient with heritable conditions such as Autosomal dominant polycystic kidney disease (ADPKD), glucocorticoid remediable hyperaldosteronism (GRA), and connective tissue diseases. [4][5][6]

Screening

First degree relatives screening

The risk of having subarachnoid hemorrhage (SAH) is much higher in individuals with a positive family history of first degree relatives with cerebral aneurysm compare to the general population and aneurysms tend to rupture at a smaller size and younger age than sporadic aneurysms.[7][8] This risk of aneurysm is also influenced by other risk factors such as cigarette smoking and hypertension.[9] The mode of inheritance can be variable, with autosomal dominant, recessive, and multifactorial transmission.

  • First-degree relatives screening is recommend in individuals with a positive family history of subarachnid hemorrhage or cerebral aneurysm in more than two family members.[1][2]
  • Screening is not recommend in individuals with only one affected first-degree relative.[3]

Heritable conditions screening

Time of screening

Familiar:[7]

  • Siblings often experience rupture in the same decade of life. It is not likely that individuals develop SAH at younger ages than previous generations

Heritable:[10]

  • Aneurysm rupture in ADPKD most often occurs before the age of 50 and in patients with poorly controlled hypertension

Screening test

  • MRA (identify aneurysms 3 to 5 mm or larger)[11][12][13]
  • CTA (miss aneurysms smaller than 3 mm, also may have false positive results)[14]

References

  1. 1.0 1.1 Bederson JB, Awad IA, Wiebers DO, Piepgras D, Haley EC, Brott T; et al. (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 (18): 2300–8. PMID 11056108. 
  2. 2.0 2.1 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839
  3. 3.0 3.1 Schievink WI (1997). "Intracranial aneurysms.". N Engl J Med. 336 (1): 28–40. PMID 8970938. doi:10.1056/NEJM199701023360106. 
  4. 4.0 4.1 Pepin M, Schwarze U, Superti-Furga A, Byers PH (2000). "Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type.". N Engl J Med. 342 (10): 673–80. PMID 10706896. doi:10.1056/NEJM200003093421001. 
  5. 5.0 5.1 Chauveau D, Pirson Y, Verellen-Dumoulin C, Macnicol A, Gonzalo A, Grünfeld JP (1994). "Intracranial aneurysms in autosomal dominant polycystic kidney disease.". Kidney Int. 45 (4): 1140–6. PMID 8007584. 
  6. 6.0 6.1 Litchfield WR, Anderson BF, Weiss RJ, Lifton RP, Dluhy RG (1998). "Intracranial aneurysm and hemorrhagic stroke in glucocorticoid-remediable aldosteronism.". Hypertension. 31 (1 Pt 2): 445–50. PMID 9453343. 
  7. 7.0 7.1 Ronkainen A, Hernesniemi J, Puranen M, Niemitukia L, Vanninen R, Ryynänen M; et al. (1997). "Familial intracranial aneurysms.". Lancet. 349 (9049): 380–4. PMID 9033463. doi:10.1016/S0140-6736(97)80009-8. 
  8. Raaymakers TW (1999). "Aneurysms in relatives of patients with subarachnoid hemorrhage: frequency and risk factors. MARS Study Group. Magnetic Resonance Angiography in Relatives of patients with Subarachnoid hemorrhage.". Neurology. 53 (5): 982–8. PMID 10496256. 
  9. Rasing I, Nieuwkamp DJ, Algra A, Rinkel GJ (2012). "Additional risk of hypertension and smoking for aneurysms in people with a family history of subarachnoid haemorrhage.". J Neurol Neurosurg Psychiatry. 83 (5): 541–2. PMID 22423116. doi:10.1136/jnnp-2011-301147. 
  10. Schievink WI, Torres VE, Piepgras DG, Wiebers DO (1992). "Saccular intracranial aneurysms in autosomal dominant polycystic kidney disease.". J Am Soc Nephrol. 3 (1): 88–95. PMID 1391712. 
  11. Huston J, Nichols DA, Luetmer PH, Goodwin JT, Meyer FB, Wiebers DO; et al. (1994). "Blinded prospective evaluation of sensitivity of MR angiography to known intracranial aneurysms: importance of aneurysm size.". AJNR Am J Neuroradiol. 15 (9): 1607–14. PMID 7857409. 
  12. Huston J, Torres VE, Sulivan PP, Offord KP, Wiebers DO (1993). "Value of magnetic resonance angiography for the detection of intracranial aneurysms in autosomal dominant polycystic kidney disease.". J Am Soc Nephrol. 3 (12): 1871–7. PMID 8338918. 
  13. Raaymakers TW, Buys PC, Verbeeten B, Ramos LM, Witkamp TD, Hulsmans FJ; et al. (1999). "MR angiography as a screening tool for intracranial aneurysms: feasibility, test characteristics, and interobserver agreement.". AJR Am J Roentgenol. 173 (6): 1469–75. PMID 10584784. doi:10.2214/ajr.173.6.10584784. 
  14. van Gelder JM (2003). "Computed tomographic angiography for detecting cerebral aneurysms: implications of aneurysm size distribution for the sensitivity, specificity, and likelihood ratios.". Neurosurgery. 53 (3): 597–605; discussion 605–6. PMID 12943576. 

Linked-in.jpg