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Continued risk of SAH after negative screen in first-degree relatives—and persistent questions

Intracranial aneurysms (IAs) typically develop throughout life, necessitating vigilance in those at high risk in order to avoid aneurysmal subarachnoid hemorrhage (aSAH), the deadly complication of IA. A family history of IA increases personal risk of IA development and rupture: the odds ratio (OR) of subarachnoid hemorrhage (SAH) in persons with one first-degree relative (FDR) is 2.15 while the OR of those with 2 affected FDRs increases to 51.0.1 In patients with 2 affected FDRs (typically the definition of “familial” IA), it is cost-effective to repeatedly screen for development of de novo aneurysms, with an optimal screening interval of 7 years.2