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How to Manage the Patient With a Family History of Aneurysmal Subarachnoid Haemorrhage

Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK; E-mail: pmw{at}skull.dcn.ed.ac.uk

EXTRACT

INTRODUCTION

‘The truth is rarely pure and never simple’. So said Oscar Wilde, and this is certainly the case for individuals with an unruptured intracranial aneurysm or a family history of aneurysmal subarachnoid haemorrhage (SAH). Before you can counsel these people, it is first necessary for the clinician to have a grasp of this complex area because once you have told the patient something it cannot be untold. You might subsequently expand on the information imparted, but you cannot remove it – correct or incorrect – from the patient’s mind (Fuller 2001). In this article I will summarize the relevant knowledge, and offer some advice, on management in this rather fraught area of medicine.

There are several stages of assessment and management to consider:

• What is an individual’s risk of harbouring an aneurysm?
  
• How best to detect an aneurysm without exposing the patient to unnecessary stress or risk?
  
• If
  

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