Morbidity of intracranial hemorrhage in patients with cerebral arteriovenous malformation

• Published in: Stroke (1970) Vol. 29; no. 5; pp. 931 - 934
• Main Authors: HARTMANN, A, MAST, H, MOHR, J. P, KOENNECKE, H.-C, OSIPOV, A, PILE-SPELLMAN, J, HOANG DUONG, D, YOUNG, W. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.1998; American Heart Association, Inc
• Subjects: Activities of Daily Living; Adolescent; Adult; Aged; Biological and medical sciences; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - epidemiology; Cerebral Hemorrhage - mortality; Cerebral Ventricles - blood supply; Cerebral Ventricles - pathology; Child; Female; Follow-Up Studies; Humans; Incidence; Intracranial Aneurysm - complications; Intracranial Arteriovenous Malformations - complications; Male; Medical sciences; Middle Aged; Morbidity; Neurologic Examination; Neurology; New York - epidemiology; Prospective Studies; Recurrence; Severity of Illness Index; Subarachnoid Hemorrhage - complications; Vascular diseases and vascular malformations of the nervous system; New York; Human; Intracranial; Nervous system diseases; Prognosis; Cardiovascular disease; Psychometrics; Congenital disease; Epidemiology; Hemorrhage; Morbidity; Cerebral disorder; Vascular disease; Central nervous system disease; Functional dependence; Complication; Evolution; Localization; Neurological disorder; Cerebrovascular disease; Arteriovenous malformation
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.29.5.931

Decisions on invasive arteriovenous malformation (AVM) treatment are currently based on natural-course risk estimates of AVM bleeding and assumptions on morbidity from cerebral hemorrhage in general. However, morbidity of AVM hemorrhage has rarely been reported. We sought to assess the morbidity of intracranial hemorrhage in patients with cerebral AVMs. From a prospective AVM database, 119 patients were analyzed: 115 had a hemorrhage as the diagnostic event, and 27 of them suffered a second hemorrhage during follow-up; an additional 4 patients had other diagnostic symptoms but bled during follow-up. The type (parenchymal, subarachnoid, intraventricular) and location of AVM hemorrhage were determined by CT/MR brain imaging. Disability and neurological impairment were assessed with the Barthel Index, the Rankin Scale, and the National Institutes of Health Stroke Scale, with a mean follow-up time of 16.2 months. Of the 115 incident hemorrhages, 34 (30%) were subarachnoid, 27 (23%) parenchymal, 18 (16%) intraventricular, and 36 (31%) in combined locations. In 54 patients (47%; 95% confidence interval [CI], 38% to 56%) the incident hemorrhage resulted in no neurological deficit, and an additional 43 patients (37%; 95% CI, 28% to 46%) were independent in their daily activities (Rankin 1). Fifteen patients (13%; 95% CI, 7% to 19%) were moderately disabled (Rankin 2 or 3), and 3 (3%; 95% CI, 0% to 6%) were severely disabled (Rankin > or =4). Parenchymal hemorrhages were most likely to result in a neurological deficit (52%). Type and morbidity of hemorrhage during follow-up were similar to incident events. Twenty (74%) of 27 patients with both incident and follow-up hemorrhages were normal or independent (Rankin 0 or 1). None of the patients with a hemorrhage during follow-up died during the observation period. Hemorrhage from cerebral AVMs appears to have a lower morbidity than currently assumed. This finding encourages a reevaluation of the risks and benefits of invasive AVM treatment.