One quarter of patients with autosomal dominant polycystic kidney disease (ADPKD) have aneurysms at autopsy, and 2% to 8% of patients with aneurysms have ADPKD.[36]Schievink WI, Michels VV, Piepgras DG. Neurovascular manifestations of heritable connective tissue disorders. A review. Stroke. 1994 Apr;25(4):889-903. http://www.ncbi.nlm.nih.gov/pubmed/8160237?tool=bestpractice.com Individuals with ADPKD are potential candidates for aneurysm screening.[29]Rinkel GJ. Intracranial aneurysm screening: indications and advice for practice. Lancet Neurol. 2005 Feb;4(2):122-8. http://www.ncbi.nlm.nih.gov/pubmed/15664544?tool=bestpractice.com
Because of the possible hereditary aspects of subarachnoid hemorrhage (SAH), patients who have two or more first-degree relatives with SAH are potential candidates for aneurysm screening.[25]Thompson BG, Brown RD Jr, Amin-Hanjani S, et al. Guidelines for the management of patients with unruptured intracranial aneurysms: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015 Aug;46(8):2368-400. https://www.doi.org/10.1161/STR.0000000000000070 http://www.ncbi.nlm.nih.gov/pubmed/26089327?tool=bestpractice.com [29]Rinkel GJ. Intracranial aneurysm screening: indications and advice for practice. Lancet Neurol. 2005 Feb;4(2):122-8. http://www.ncbi.nlm.nih.gov/pubmed/15664544?tool=bestpractice.com [35]Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013 Feb 7;35(2):93-112. https://www.karger.com/Article/FullText/346087 http://www.ncbi.nlm.nih.gov/pubmed/23406828?tool=bestpractice.com
Hypertension should be corrected, as this is one of the most important modifiable risk factors.[26]Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg. 2000 Sep;93(3):379-87. http://www.ncbi.nlm.nih.gov/pubmed/10969934?tool=bestpractice.com [29]Rinkel GJ. Intracranial aneurysm screening: indications and advice for practice. Lancet Neurol. 2005 Feb;4(2):122-8. http://www.ncbi.nlm.nih.gov/pubmed/15664544?tool=bestpractice.com [30]Broderick JP, Viscoli CM, Brott T, et al; Hemorrhagic Stroke Project Investigators. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke. 2003 Jun;34(6):1375-81. http://www.ncbi.nlm.nih.gov/pubmed/12764233?tool=bestpractice.com [31]Feigin VL, Rinkel GJ, Lawes CM, et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005 Dec;36(12):2773-80. http://www.ncbi.nlm.nih.gov/pubmed/16282541?tool=bestpractice.com [32]Juvela S. Prehemorrhage risk factors for fatal intracranial aneurysm rupture. Stroke. 2003 Aug;34(8):1852-7. http://www.ncbi.nlm.nih.gov/pubmed/12829865?tool=bestpractice.com [33]Qureshi AI, Suri MF, Yahia AM, et al. Risk factors for subarachnoid hemorrhage. Neurosurgery. 2001 Sep;49(3):607-12. http://www.ncbi.nlm.nih.gov/pubmed/11523670?tool=bestpractice.com [34]Teunissen LL, Rinkel GJ, Algra A, et al. Risk factors for subarachnoid hemorrhage: a systematic review. Stroke. 1996 Mar;27(3):544-9. https://www.ahajournals.org/doi/10.1161/01.STR.27.3.544 http://www.ncbi.nlm.nih.gov/pubmed/8610327?tool=bestpractice.com
Smoking is another important modifiable risk factor.[26]Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture. J Neurosurg. 2000 Sep;93(3):379-87. http://www.ncbi.nlm.nih.gov/pubmed/10969934?tool=bestpractice.com [30]Broderick JP, Viscoli CM, Brott T, et al; Hemorrhagic Stroke Project Investigators. Major risk factors for aneurysmal subarachnoid hemorrhage in the young are modifiable. Stroke. 2003 Jun;34(6):1375-81. http://www.ncbi.nlm.nih.gov/pubmed/12764233?tool=bestpractice.com [31]Feigin VL, Rinkel GJ, Lawes CM, et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005 Dec;36(12):2773-80. http://www.ncbi.nlm.nih.gov/pubmed/16282541?tool=bestpractice.com [32]Juvela S. Prehemorrhage risk factors for fatal intracranial aneurysm rupture. Stroke. 2003 Aug;34(8):1852-7. http://www.ncbi.nlm.nih.gov/pubmed/12829865?tool=bestpractice.com [33]Qureshi AI, Suri MF, Yahia AM, et al. Risk factors for subarachnoid hemorrhage. Neurosurgery. 2001 Sep;49(3):607-12. http://www.ncbi.nlm.nih.gov/pubmed/11523670?tool=bestpractice.com [34]Teunissen LL, Rinkel GJ, Algra A, et al. Risk factors for subarachnoid hemorrhage: a systematic review. Stroke. 1996 Mar;27(3):544-9. https://www.ahajournals.org/doi/10.1161/01.STR.27.3.544 http://www.ncbi.nlm.nih.gov/pubmed/8610327?tool=bestpractice.com All patients should be encouraged not to smoke.