Cerebral Aneurysms in Polycystic Kidney Disease

One of the extra-renal manifestations of autosomal dominant polycystic kidney is the presence of cerebral aneurysms. Since often these aneurysms are asymptomatic until they rupture, causing severe neurologic problems as well as possibly being fatal, one might think that all patients with ADPKD should be screened using either MRI or CT scan. However, it appears that one of the strongest risk factors for aneurysms in this population is family history--and in ADPKD patients without a family history of aneurysms, their risk begins to approach that of the general population. Thus, the current recommendations for screening for cerebral aneurysms in patients with ADPKD involve only screening those with a positive family history of aneurysms, or (obviously) if they are having any symptoms of headache or other neurologic problem.