Brain Advance Access originally published online on April 7, 2005
Brain 2005 128(7):1677-1685; doi:10.1093/brain/awh497
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The familial risk of subarachnoid haemorrhage
1 University Department of Neurosurgery and 2 Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, Glasgow, 3 University of Edinburgh, Division of Clinical Neurosciences, Western General Hospital and 4 University of Edinburgh, Public Health Sciences, Medical School, Edinburgh, UK
Correspondence to: Professor J. M. Wardlaw, Division of Clinical Neurosciences, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK E-mail: joanna.wardlaw{at}ed.ac.uk
Relatives of people with aneurysmal subarachnoid haemorrhage (SAH) may be at increased risk of SAH, but precise data on the level of risk and which relatives are most likely to be affected are lacking. We studied two samples: 5478 relatives of patients from the whole of Scotland who had a SAH in one year and 3213 relatives of patients with a SAH admitted to the West of Scotland regional neurosurgical unit 10 years previously. Overall, 2% of all relatives in each sample had a SAH. In the Scotland-wide sample, the absolute lifetime risk of SAH (from birth to 70 years) was higher for first-degree relatives [4.7%; 95% confidence interval (CI): 3.1–6.3%] than for second-degree (1.9%; 95% CI: 1.0–2.9%). In the West of Scotland sample, the lifetime risks were very similar to the Scotland-wide sample. The 10-year prospective risk for first-degree relatives alive at the time of the index patient's SAH was 1.2% (95% CI: 0.4–2%) and for second-degree was 0.5% (95% CI: 0.1–0.8%). There was a trend for risk to be highest in families with two first-degree relatives affected and lowest with only one second-degree affected. Most living relatives of patients who suffer a SAH are at low absolute risk of a future haemorrhage; screening is inappropriate except for the few families in whom two or more first-degree relatives, i.e. index case plus one extra have been affected.
Key Words: subarachnoid haemorrhage; intracranial aneurysm; familial risk; epidemiology; screening
Abbreviations: CHI = Community Health Index; CI = confidence interval; ISD = Scottish Office Information and Statistics Division; MRA = magnetic resonance angiography; SAH = subarachnoid haemorrhage
Received July 15, 2004. Revised December 8, 2004. Accepted March 7, 2005.
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