Targeted screening may prevent dangerous cerebral hemorrhages in middle-aged women who smoke

Intracranial aneurysms, which are weakened parts in the cerebrovascular walls, occur in approximately 2 or 3 per cent of the population. Most of these aneurysms do not cause symptoms, but a small number of them rupture and cause a life-threatening subarachnoid hemorrhage. In Finland, 40 per cent of such hemorrhages lead to death.

Intracranial aneurysms are not hereditary but usually develop in adulthood as a result of smoking and high blood pressure. Smoking is the most significant risk factor for the rupture of intracranial aneurysms, and according to previous Finnish studies, the risk is exceptionally high in middle-aged women who smoke.

A total of 108 female smokers aged 50–60 were screened in a study conducted at the Helsinki University Hospital Department of Neurosurgery. As many as 10 per cent of them were diagnosed with an aneurysm. Most of the aneurysms were small, which means that the primary treatment consists of giving up smoking and good control of blood pressure. The aneurysms of two women were treated with preventive surgery.

“Not all intracranial aneurysms require surgery or an endovascular procedure. Giving up smoking or good control of hypertension are often enough to reduce the risk of bleeding from the aneurysm,” explains neurosurgeon Justiina Huhtakangas, the principal investigator of the study.

The benefits and disadvantages of screening intracranial aneurysms must be weighed

There are approximately 38,000 female smokers aged 50–60 in Finland. At least some of them could benefit from screening. It is still not possible to issue an official recommendation on extending the screening on the basis of this study.

“This is the first study in which screening is targeted at people who are known to be at a particularly high risk of developing subarachnoid hemorrhage and dying from the disease. Screening and addressing the risk factors, which are smoking and high blood pressure, may reduce premature deaths in this risk group even without surgical or endovascular treatment,” says Miikka Korja, a neurosurgeon specialized in cerebrovascular diseases, who is also one of the research physicians in the screening study.

The neurosurgeons at HUS stress that the benefits and advantages of screening must still be evaluated carefully. Screening may also cause overtreatment and morbidity if even all the small intracranial aneurysms detected are treated with procedures. Procedures always involve risks of complications. It is essential to inform the patients well and support them.

Supporting giving up smoking in connection with the screening could provide significant health benefits. Additional studies on the effectiveness and long-term benefits of screening are due both in Finland and internationally.

Link to research article: Huhtakangas, Vasankari, Numminen, Niemelä, Korja: Targeted Screening of Unruptured Intracranial Aneurysms in Female Smokers: Inconsiderate Overdiagnosis or Chance for Better Health? Stroke, 2025.

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