Clinical and morphological determinants of focal neurological deficits in patients with unruptured brain arteriovenous malformation

• Published in: Journal of the neurological sciences Vol. 287; no. 1; pp. 126 - 130
• Main Authors: Choi, J.H, Mast, H, Hartmann, A, Marshall, R.S, Pile-Spellman, J, Mohr, J.P, Stapf, C
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 15.12.2009; Elsevier
• Subjects: Adult; Arteriovenous malformation; Biological and medical sciences; Brain - blood supply; Brain - pathology; Brain - physiopathology; Brain arteriovenous malformation; Brain Diseases - epidemiology; Brain Diseases - pathology; Brain Diseases - physiopathology; Cerebellar Diseases - epidemiology; Cerebellar Diseases - pathology; Cerebellar Diseases - physiopathology; Cerebral Arteries - pathology; Cerebral Arteries - physiopathology; Cerebral Veins - pathology; Cerebral Veins - physiopathology; Cognition Disorders - epidemiology; Cognition Disorders - pathology; Cognition Disorders - physiopathology; Comorbidity; Disease Progression; Female; Focal neurological deficits; Humans; Intracranial Arteriovenous Malformations - epidemiology; Intracranial Arteriovenous Malformations - pathology; Intracranial Arteriovenous Malformations - physiopathology; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Natural history; Neurology; Paresis - epidemiology; Paresis - pathology; Paresis - physiopathology; Predictive Value of Tests; Prospective Studies; Sensation Disorders - epidemiology; Sensation Disorders - pathology; Sensation Disorders - physiopathology; Focal neurological deficits; Brain arteriovenous malformation; Arteriovenous malformation; Natural history; Vascular disease; Human; Nervous system diseases; Cardiovascular disease; Intracranial arteriovenous malformation; Congenital disease
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2009.08.011

Abstract Objective Some patients with brain arteriovenous malformation (BAVM) present with focal neurological deficits (FNDs) unrelated to clinically discernable seizure activity or hemorrhage. The aim of this study is to determine demographic and morphological AVM characteristics associated with FNDs. Methods The 735 patients of the prospective Columbia AVM Databank were analyzed. Univariate and multivariate statistical models were used to test the association of demographic (age, gender), and morphological characteristics (BAVM size, anatomic location, arterial supply, venous drainage pattern, venous ectasia) with the occurrence of FNDs at the time of initial BAVM diagnosis. Results Fifty-three patients (7%, mean age 40 ± 16 years, 70% women) presented with FNDs. The multivariate logistic regression model revealed an independent association of FNDs with increasing age (OR 1.03; 95%-CI 1.00–1.05), female gender (OR 2.14; 95%-CI 1.15–3.97), deep brain location (OR 2.46; 95%-CI 1.24–4.88), brainstem location (OR 5.62; 95%-CI 1.65–19.23), and venous ectasia (OR 1.91; 95%-CI 1.01–3.64). No association was found for BAVM size, lobar location, arterial supply and venous drainage pattern. Interpretation Focal neurologic deficits unrelated to seizures or hemorrhage are a rare initial presentation of BAVMs. The predominance of FNDs among brainstem and deeply located BAVMs and the lack of a significant association of BAVM size with FNDs indicate selective white matter pathway-specific vulnerability, the association with patient age a time dependent effect. The higher frequency of FNDs among women suggests gender-specificity of brain tissue vulnerability.