The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations

Abstract

Background and Purpose-Patients harboring brain arteriovenous malformations (bAVMs) are at a lifelong risk for hemorrhagic strokes, but the natural history is poorly understood. We examined the impact of demographic and angiographic features on the likelihood of future hemorrhage. Methods-A prospectively accrued database of bAVM patients maintained at the Toronto Western Hospital was analyzed; 678 consecutive, prospectively enrolled bAVM patients were followed for 1931.7 patient-years. The rate of hemorrhage over long-term follow-up was recorded. The impact of baseline clinical and radiographic features and partial treatment on time to hemorrhage were analyzed using survival analysis. Neurological outcome after hemorrhage was assessed using the Glasgow Outcome Score. Results-Hemorrhage rates were 4.61% per year for the entire cohort (nϭ678), 7.48% per year for bAVMs with initial hemorrhagic presentation (nϭ258), 4.16% per year for initial seizure presentation (nϭ260)

On apples, oranges, and ARUBA

“…However, such patients represent a large portion of those with unruptured AVMs in the community, thereby compromising the generalisability of the study's findings. Furthermore, as the different AVM treatment modalities have progressed considerably during the last two decades [5,8,11,21,23], the threshold for proposing a prophylactic treatment of AVMs considered to harbour a high risk of rupture has been lowered, despite the results of different studies regarding the rupture risk factors [4,6,8,9,20]. Consequently, the patients included in ARUBA had possibly low-risk AVMs with a more favourable natural history.…”

Anesthetic management during cesarean delivery in a pregnant woman with ruptured cerebral arteriovenous malformation -A case report-

“…The cause of cerebral AVM is unknown, but AVM is usually congenital and forms during the third week of fetal development. Although the prevalence of cerebral AVM in humans cannot be precisely determined, AVM is uncommon and estimates vary from about 0.001% to 0.5% of the population [1,[9][10][11]. AVM is frequently asymptomatic and therefore remains undiagnosed [4], but AVMs can cause severe and devastating effects when they bleed.…”

“…Several case reports and at least one single-center analysis have suggested that pregnancy increases the risk for hemorrhagic stroke, which can be partly explained by an increased tendency for cerebral AVMs to rupture during pregnancy [9]. It has been reported that pregnant women may have a four times greater risk of AVM rupture than non-pregnant women [7].…”

Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

“…tion of Glubran 2, though the injection time is short. The majority of our patients were ruptured AVMs, so aggressive treatment to prevent recurrent hemorrhage was reasonable, considering the relatively higher rebleeding rate for AVM patients with hemorrhage presentation [9][10][11] . Several factors such as the angioarchitecture of the AVM, blood flow rate, and operator experience could affect the final results.…”