‘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?
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