Neurological event prediction for patients with symptomatic cerebral cavernous malformation: the BLED2 score

Abstract

OBJECTIVE Retrospective patient cohort studies have identified risk factors associated with recurrent focal neurological events in patients with symptomatic cerebral cavernous malformations (CCMs). Using a prospectively maintained database of patients with CCMs, this study identified key risk factors for recurrent neurological events in patients with symptomatic CCM. A simple scoring system and risk stratification calculator was then created to predict future neurological events in patients with symptomatic CCMs. METHODS This was a dual-center, prospectively acquired, retrospectively analyzed cohort study. Adult patients who presented with symptomatic CCMs causing focal neurological deficits or seizures were uniformly treated and clinically followed from the time of diagnosis onward. Baseline variables included age, sex, history of intracerebral hemorrhage, lesion multiplicity, location, eloquence, size, number of past neurological events, and duration since last event. Stepwise multivariable Cox regression was used to derive independent predictors of recurrent neurological events, and predictive accuracy was assessed. A scoring system based on the relative magnitude of each risk factor was devised, and Kaplan-Meier curve analysis was used to compare event-free survival among patients with different score values. Subsequently, 1-, 2-, and 5-year neurological event rates were calculated for every score value on the basis of the final model. RESULTS In total, 126 (47%) of 270 patients met the inclusion criteria. During the mean (interquartile range) follow-up of 54.4 (12–66) months, 55 patients (44%) experienced recurrent neurological events. Multivariable analysis yielded 4 risk factors: bleeding at presentation (HR 1.92, p = 0.048), large size ≥ 12 mm (HR 2.06, p = 0.016), eloquent location (HR 3.01, p = 0.013), and duration ≤ 1 year since last event (HR 9.28, p = 0.002). The model achieved an optimism-corrected c-statistic of 0.7209. All factors were assigned 1 point, except duration from last event which was assigned 2 points. The acronym BLED2 summarizes the scoring system. The 1-, 2-, and 5-year risks of a recurrent neurological event ranged from 0.6%, 1.2%, and 2.3%, respectively, for patients with a BLED2 score of 0, to 48%, 74%, and 93%, respectively, for patients with a BLED2 score of 5. CONCLUSIONS The BLED2 risk score predicts prospective neurological events in symptomatic CCM patients.

Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study

“…We did not identify infratentorial location as being a significant factor associated with haemorrhage, something that was identified in their manuscript, and other papers [ 20 ]. A recent multi-centre, prospective study examining risk of CCM haemorrhage on multivariable analysis identified large size, eloquent location, and shorter time since last haemorrhage event to be significantly associated with haemorrhage [ 21 ]. Our study identified both large size, eloquent location, and previous symptomatic haemorrhage to be significant, with all of these factors being incorporated into a bleeding risk calculator proposed by the same authors [ 21 ].…”

“…These can be used by clinicians to help categorise haemorrhage risk, and develop patient-focussed management strategies for each CCM, as opposed to each patient. These features have already begun to be utilised in haemorrhage risk calculators [ 21 ].…”

Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas

“…Although relatively low marginal doses are applied compared with malignant tumors, the optimum treatment dose remains uncertain [ 47 ]. Therefore, it is thought that this study, which used a fairly homogeneous dose, considering the number of cases, will contribute to the formation of the literature [ 48 ].…”