The clinical characteristics and treatment of cerebral AVM in pregnancy

Lv, Xianli; Li, Youxiang

doi:10.1177/1971400915609332

Cited by 20 publications

(17 citation statements)

References 31 publications

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“…Two narrative reviews were excluded (20,21). The most recent case-series -using a self-controlled method in large hospital-based, retrospective Chinese cohortshowed a decreased hemorrhage risk associated with pregnancy, delivery, and puerperium (19).…”

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confidence: 99%

Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations

Beijnum

Wilkinson²,

Whitaker

et al. 2017

International Journal of Stroke

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Background It is unclear whether the risk of bleeding from brain arteriovenous malformations is higher during pregnancy, delivery, or puerperium. We compared occurrence of brain arteriovenous malformation hemorrhage in women during this period with occurrence of hemorrhage outside this period during their fertile years. Methods We included all women with ruptured brain arteriovenous malformations (16-41 years) from a retrospective database of patients with brain arteriovenous malformations in four Dutch university hospitals (n = 95) and from the population-based Scottish Audit of Intracranial Vascular Malformations (n = 44). We estimated the relative rate of brain arteriovenous malformation rupture (before any treatment) during exposed time (pregnancy, delivery, puerperium) versus non-exposed time during fertile years, using the case-crossover design as primary analysis, and the self-controlled case-series design as secondary analysis. Results In 17 of 95 Dutch women and in 3 of 44 Scottish women, hemorrhages occurred while pregnant; none occurred during delivery or puerperium. In Dutch women, the relative rate of brain arteriovenous malformation rupture during pregnancy, delivery, or puerperium was 6.8 (95% confidence interval 3.6-13) according to the case-crossover method and 7.1 (95% confidence interval 3.4-13) using the self-controlled case-series method. In Scottish women, the relative rate was 1.3 (95% confidence interval 0.39-4.1) using the case-crossover method and 1.7 (95% confidence interval 0.0-4.4) according to the self-controlled case-series method. Because of limited overlap of confidence intervals, we refrained from pooling the cohorts. Conclusions Case-crossover and self-controlled case series analyses reveal an increase in relative rate of brain arteriovenous malformation rupture during pregnancy in the Dutch cohort but not in the Scottish cohort. Since point estimates varied between both cohorts and numbers are relatively small, the clinical implications of our findings are uncertain.

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confidence: 99%

Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations

Beijnum

Wilkinson²,

Whitaker

et al. 2017

International Journal of Stroke

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“…Cerebral AVM is a rare congenital lesion (0.01%–0.5%), which is an abnormal communication between cerebral arterial and venous systems with no intervening capillary bed 1–3. This affects women in their third to fifth decade of life and usually presents before 40 years of age 3 5–7. Cerebral AVM has a high possibility of rupture during pregnancy due to increase in cardiac output and elevated oestrogen levels in pregnancy 1–3 5 6.…”

Section: Discussionmentioning

confidence: 99%

“…Though the rupture of an intracranial AVM in pregnancy is rare (0.6%–3.5%), however, it leads to serious feto-maternal complications 15. Regarding maternal mortality due to AVM, there are multiple studies quoting an incidence of 10%–40%6 7 15–17 and fetal mortality of 14% 7…”

Section: Discussionmentioning

confidence: 99%

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Cerebral arteriovenous malformations during pregnancy: a management dilemma

et al. 2019

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The rupture of a brain cranial arteriovenous malformation (bAVM) has been associated with pregnancy; however, due to scarcity of data about this rare condition, management still remains a dilemma both for obstetricians and neurophysicians. The management plan is decided after weighing the benefits of bAVM treatment against the risk of bleeding in pregnancy. There is consensus on deciding the treatment of ruptured brain AVM during pregnancy based on neurological and not obstetrical indications. The management is decided using a multidisciplinary approach.We report the case of a primigravida who presented at 15 weeks of gestation with intracranial haemorrhage secondary to ruptured bAVM, which was managed by glue embolisation. However, she presented again after 9 days in a moribund condition with fever, vomiting and malaise. The family was very concerned about the patient. The multidisciplinary team after evaluation of patient decided for hysterotomy based on the deteriorating maternal condition.

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“…A previous study used gamma knife radiotherapy for treatment (27); however, it has a long treatment cycle, its effectiveness has not been well documented and re-bleeding may occur (28,29). The present study describes a young pregnant woman with a large AVM, wide draining veins and a high risk of endovascular complications.…”

Section: Discussionmentioning

confidence: 99%

Treatment of a giant arteriovenous malformation associated with intracranial aneurysm rupture during pregnancy: A case report

Chen

Wang

et al. 2016

Experimental and Therapeutic Medicine

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Arteriovenous malformations (AVMs) associated with aneurysm have rarely been reported in the literature. The present study reports the case of a 21-year-old pregnant female patient who presented with a subarachnoid hemorrhage and an intracranial hematoma located in the anterior end of the corpus callosum. Furthermore, an anterior cerebral aneurysm and an AVM were identified by digital subtraction angiography and magnetic resonance angiography. The aneurysm was clipped and the AVM was successfully removed by microsurgery. The diagnosis of AVM associated with an aneurysm was confirmed via intraoperative and postoperative pathological examinations. By performing a review of the current literature, issues and surgical considerations associated with AVM associated with aneurysm were analyzed.

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The clinical characteristics and treatment of cerebral AVM in pregnancy

Cited by 20 publications

References 31 publications

Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations

Relative risk of hemorrhage during pregnancy in patients with brain arteriovenous malformations

Cerebral arteriovenous malformations during pregnancy: a management dilemma

Treatment of a giant arteriovenous malformation associated with intracranial aneurysm rupture during pregnancy: A case report

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