Cerebral Aneurysms in Polycystic Kidney Disease

[okarol]

Saturday, January 10, 2009
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.
Posted by nathanhellman at 11:48 PM

http://renalfellow.blogspot.com/2009/01/cerebral-aneurysms-in-polycystic-kidney.html

[pelagia]

This is becoming a possible issue for a relative, who also has PKD.  He had two "episodes" of short-term memory loss last year, which might be related to very small brain aneurysms.  Both episodes occurred after he worked out at the gym.  They are yet to definitively pinpoint the cause.  I believe that one issue is that the contrast medium used when they do scanning is toxic to the kidney.  Thus, they do not want to use the normal procedure and they are unable to get really good contrast in his scans.

This site gives additional information about the problem: http://www.aakp.org/aakp-library/Inherited-kidney-disease-PKD/

"Approximately 4-8 percent of people with PKD have small aneurysms – blood vessel outpouchings caused by weakness in blood vessel walls – in the blood vessels in the brain (intracranial aneurysms), and rarely in the aorta (the large artery from the heart feeding other blood vessels). Brain aneurysms occur in small numbers (less than 5 percent) of PKD families. Since a ruptured brain aneurysm can be life threatening, tests to look for brain aneurysms have been advised for PKD patients with a family history of brain aneurysms. A three-dimensional magnetic resonance arteriogram (MRA) test can find such aneurysms. Small aneurysms are probably safe to watch and follow over time. Larger ones can be treated surgically, or with microsurgical clipping, or a radiologist placing small coils in the aneurysms through a catheter to clot them."

[paul.karen]

Hummm,
Times like this that i wish i knew my family history much beter then i do...........

[okarol]

My dad had PKD and died from an aneurysm at 28 years old. He had high BP for probably 10 years. It sounds like anyone with a similar family history could benefit from a scan, but as pelagia mentions, the contrast dye is bad news for kidney patients.

[charee]

We all had to have a brain scan when we were first found out we had PKD didn't need any dye , just had to lie very still in the tunnell freaked me out abit but none of us had any aneurysms, one good thing , we also had to have a heart test as some people with PKD can have a faulty valve ( I think its a valve it was a few years ago)

[pelagia]

I believe they can see the aneurysms without the dye, but I think the problem arises if it's a little aneurysm and a little bit of leaking.  Without the contrast the dye gives, it's hard to figure out what is going on.