Author/Authors :
Toshio Nakagawa، نويسنده , , Kazuo Hashi، نويسنده , , Sumiyoshi Tanabe، نويسنده , , Akinori Yamamura، نويسنده ,
Abstract :
The importance of screening people with a family history of subarachnoid hemorrhage (SAH) within the second degree of consanguinity for preventing SAH is discussed in this report. The authors have reported significantly higher incidence of unruptured cerebral aneurysms shown in the “brain dock” volunteers with a family history of SAH within the same range and pointed out the necessity to recognize them as a high-risk group of possible unruptured cerebral aneurysms. In the present study, 225 patients with a family history of SAH within the same range who were either admitted to our hospital or visited outpatients after May 1993 were investigated with respect to the incidence of possible unruptured cerebral aneurysms and its relation to the risk factors of arteriosclerosis. The subjects were restricted to those who had no symptoms or history of either SAH or cerebral aneurysms and in whom cerebral aneurysms were confirmed by cerebral angiography such as MRA, 3D-CTA, and IA-DSA. As a result, thirty-seven unruptured cerebral aneurysms were found in 30 cases (13.3%) among the subjects. Six of the cases showed multiple aneurysms (20.0%). The distribution of aneurysms was: 14 (37.8%) in the internal carotid artery, 16 (43.2%) in the middle cerebral artery, 3 (8.1%) in the anterior communicating artery, 2 (5.4%) in the basilar artery, and one (2.7%) in both the vertebral artery and distal arterior cerebral artery. As to the relationship between family history of aneurysm and the discovery rate, aneurysms were found in 13 out of 109 (11.9%) patients with a history of aneurysms in parents, in 15 of 95 (15.8%) patients with a history in siblings, 0 of 6 (0%) patients with a history in grandparents, and in 2 of 15 (13.3%) patients with multiple family history. As for the relationship between risk factors and incidence of aneurysms, hypertension was associated in 20.6% of the cases, diabetes mellitus in 28.6%, hyperlipidemia in 26.3%, smoking in 14.3%, multiple risk factors in 30.4%, and aneurysms were detected in 9.9% of the patients with no risk factors and in 12.5% with cerebral infarction. Thus a high incidence of unruptured cerebral aneurysms was found in cases with a family history of SAH within the second degree of consanguinity as found in the brain dock volunteers. Such cases can be defined as a high-risk group and aggressive screening for cerebrovascular disease, as well as detailed examination, for this group is very important and could improve SAH prevention, particularly for those who have multiple risk factors.
