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        有两个理由认为脑动脉瘤进行筛查是正当的，第一，脑动脉瘤蛛网膜下腔出血的预后非常悲惨；第二，对大部分无症状脑动脉瘤进行治疗的并发症少于5%，死亡率小于2%。[1,2]。但是，阻碍对脑动脉瘤进行筛查的理由也有两个，无症状脑动脉瘤的自然病史并没有很好地界定；筛选的获益也从来没有被量化。筛查方案中可能的警告是基于证明颅内动脉瘤可能在短期内（月，周，甚至数天）破裂，要么立即破裂，要么相当稳定不破裂[3~5]。

       为提高筛查的效率，确定筛查的高危人群非常重要。有人建议筛选两组有可能发展为脑动脉瘤的高危人群，一是那些有脑动脉瘤家族病史的人群[5~7]和常染色体显性多囊肾患者[8~12]。目前在没有任何临床表现或生物标志物，可以识别最有可能发展为颅内动脉瘤的人。筛查通常建议在家庭成员中有两个或更多患者时进行[6,7]，并只在直系亲属中进行。使用这样的筛查协议，Ronkainen等人发现396人动脉瘤患者亲属中有31人（百分之九）为无症状动脉瘤[7]。也有人建议只要有一个动脉瘤患者也对其家庭成员进行无症状脑动脉瘤的筛查[13]，但是，对于只有一个脑动脉瘤患者家庭直系亲属蛛网膜下腔出血绝对寿命风险非常小（50岁为1%，70岁为2%）[14]，不建议对这些人进行筛查。

       无症状的常染色体显性多囊肾疾病成年患者，在接受筛查时发现有脑动脉瘤患者约为5~10%[8~10]。颅内动脉瘤在常染色体显性多囊肾病家族中高发已有报道，筛选揭示无症状动脉瘤在这类家庭成员中甚至高达20~25%，因此，虽然在常染色体显性多囊肾病患者中筛查颅内动脉瘤仍有争议，大多数研究者同意，筛查适用于那些有脑动脉瘤家族史的病人[8~12]。

      Schievink报告[15]二叶式主动脉瓣（ Bicuspid aortic valve，BAV）患者可能是颅内动脉瘤高发人群。对此类病人的MRA或CTA的筛查表明，6/61 (9.8%; 95% confidence interval [CI] 2.4%-17.3%). 病例检查出无症状脑动脉瘤。对照组为3/291 [1.1%; 95% CI 0%-2.2%]) (p = 0.0012)。BAV患者显著高于对照组。

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2. King JT Jr, Berlin JA, Flamm ES. Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: a meta-analysis. J Neurosurg 1994;81:837-842.

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6. Schievink WI, Schaid DJ, Rogers HM, Piepgras DG, Michels VV. On the inheritance of intracranial aneurysms. Stroke 1994;25:2028-2037.

7. Ronkainen A, Puranen MI, Hernesniemi JA, et al. Intracranial aneurysms: MR angiographic screening in 400 asymptomatic individuals with increased familial risk. Radiology 1995;195:35-40. [免费文献]

8. Chapman AB, Rubinstein D, Hughes R, et al. Intracranial aneurysms in autosomal dominant polycystic kidney disease. N Engl J Med 1992;327:916-920. 

10.  Ruggieri PM, Poulos N, Masaryk TJ, et al. Occult intracranial aneurysms in polycystic kidney disease: screening with MR angiography. Radiology 1994;191:33-39. [免费文献]

12. Butler WE, Barker FG II, Crowell RM. Patients with polycystic kidney disease would benefit from routine magnetic resonance angiographic screening for intracerebral aneurysms: a decision analysis. Neurosurgery 1996;38:506-516. 

13. Bromberg JEC, Rinkel GJE, Algra A, et al. Subarachnoid haemorrhage in first and second degree relatives of patients with subarachnoid haemorrhage. BMJ 1995;311:288-289. [免费文献]

14. Schievink WI, Schaid DJ, Michels VV, Piepgras DG. Familial aneurysmal subarachnoid hemorrhage: a community-based study. J Neurosurg 1995;83:426-429.

15. Schievink WI, Raissi SS, Maya MM, Velebir A. Screening for intracranial aneurysms in patients with bicuspid aortic valve. Neurology. 2010 May 4;74(18):1430-3.