Early Rebleeding after Brain Arteriovenous Malformation Rupture, Clinical Impact and Predictive Factors: A Monocentric Retrospective Cohort Study

Abstract

Background: Brain arteriovenous malformations (BAVMs) are a leading cause of intracranial hemorrhage in young adults. This study aimed to identify individual predictive factors of early rebleeding after BAVM rupture and determine its impact on prognosis. Methods: Early rebleeding was defined as a spontaneous intracranial hemorrhage within 30 days of BAVM rupture in patients with nonobliterated BAVMs. One hundred fifty one patients with 158 BAVM hemorrhagic events admitted to a tertiary care center during 14 years were included. Univariate followed by multivariate logistic regression was performed to assess the impact of early rebleeding on in-hospital mortality and modified Rankin Scale (mRS) score beyond 3 months and to identify independent predictors of early rebleeding. Results: Eight early rebleeding events were observed, 6 of which occurred during the first 7 days. Early rebleeding was independently and significantly associated with poor outcome (mRS ≥3 beyond 3 months, p = 0.004) but not with in-hospital mortality (p = 0.9). Distal flow-related aneurysms (p = 0.009) and altered consciousness with a Glasgow coma scale score of 3 (p = 0.01) were independently associated with early rebleeding. Conclusions: Early rebleeding is a severe complication that can occur after BAVM-related hemorrhage. Distal flow-related aneurysms and initial altered consciousness are associated with early rebleeding.

Secondary S100B Protein Increase Following Brain Arteriovenous Malformation Rupture is Associated with Cerebral Infarction

“…In this study, early rebleeding failed to reach statistical significance in its association with S100B secondary increase. A previous study [5] found that early rebleeding was associated with poor neurological outcome but not with in-hospital mortality, and could suggest that rebleeding may not be responsible for sufficient brain cell damage to release S100B protein in the serum, unlike infarction. The low rate of secondary infarction could underpower its effect on in-hospital mortality and thus explain the lack of significance.…”

“…Markers of initial severity following BAVM rupture as well as long-term outcome have been widely studied [1,[7][8][9]. In contrast, studies evaluating the impact of early complications (and their incidence) such as rebleeding or ischemia remain scarce [5,6,10].…”

“…Furthermore, a secondary increase of S100B is described as a significant marker of severe neurological complications in routinely admitted neuro-intensive care patients [3]. Secondary complications following BAVM rupture include hydrocephalus, rebleeding, and vasospasm [4][5][6]. No study to this date has monitored S100B in ruptured BAVM beyond 48 h. The present study aims to describe S100B evolution and determine whether a secondary elevation is associated with early complications or poorer outcomes following BAVM rupture.…”

Therapeutic evaluation of a patient with ruptured intracranial aneurysm without subarachnoid hemorrhage by CT imaging: a case report

“…Recurrence of hemorrhage may also be one among the various causes for aneurysm rupture without SAH [ 6 ]. The possible mechanism may be due to protein deposition occurring around the rupture of aneurysm after the initial bleeding form a fibrinous adhesion.…”

Pendarahan Berulang Setelah 14 Tahun Pada Malformasi Arteriovena Di Serebelaris

“…Hal ini menimbulkan gejala pendarahan akibat rupturnya hubungan tersebut, [1][2] membuat MAV sebagai penyebab pendarahan intraserebral nontraumatik terbanyak pada usia <35 tahun dengan insiden sekitar 1:200.000 orang setiap tahunnya. 3 Pendarahan pada MAV dihubungkan dengan mortalitas dan morbiditas yang signifikan, serta beban biaya kesehatan selama terapi. 4 Masalah pada MAV adalah risiko untuk pendarahan berulang, antara lain pada lokasi di batang otak atau infratentorial.…”