Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation

Jae H. Choi, Henning Mast, Robert R. Sciacca, Andreas Hartmann, Alexander V. Khaw, Jay P. Mohr, Ralph L Sacco, Christian Stapf

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

Background and Purpose - The morbidity from spontaneous hemorrhage of untreated brain arteriovenous malformations (AVM) is not well described. Methods - The 241 consecutive AVM patients (mean age 37±16 years, 52% women) from the prospective Columbia AVM Databank initially presenting with hemorrhage were evaluated using the Rankin Scale (RS) and the National Institute of Health Stroke Scale (NIHSS). From the 241 AVM patients, 29 (12%) had subsequent intracranial hemorrhage during follow-up. For further comparisons, 84 non-AVM patients with intracerebral hemorrhage from the Northern Manhattan Study (NOMAS) served as a control group. Results - In 241 AVM patients presenting with hemorrhage the median RS was 2 and the median NIHSS was 1 (49% RS 0 to 1, 61% NIHSS <2). The median time between hemorrhage and clinical evaluation was 11 days (mean 219 days). Recurrent AVM hemorrhage during follow-up resulted in no significant increase in morbidity (median RS 2, P=0.004; median NIHSS 3, P=0.322; time between hemorrhage and study evaluation: median 55 days, mean 657 days). Among AVM-hemorrhage subtypes, parenchymatous AVM hemorrhage was associated with higher stroke morbidity (odds ratio, 2.9; 95% CI, 1.5 to 5.8 for NIHSS ≥2) than nonparenchymatous hemorrhages. Parenchymatous AVM hemorrhage had a significantly better outcome (median NIHSS 1) than non-AVM related hemorrhage (median NIHSS 12; P<0.0001). Conclusions - Hemorrhage, either at initial presentation or during follow-up of untreated AVM patients appears to carry a lower morbidity than intracranial hemorrhage from other causes. These findings support a careful weighing of risks from interventional treatment and natural history.

Original languageEnglish
Pages (from-to)1243-1247
Number of pages5
JournalStroke
Volume37
Issue number5
DOIs
StatePublished - May 1 2006
Externally publishedYes

Fingerprint

Arteriovenous Malformations
National Institutes of Health (U.S.)
Hemorrhage
Brain
Stroke
Intracranial Hemorrhages
Morbidity
Cerebral Hemorrhage
Natural History
Odds Ratio
Databases

Keywords

  • Cerebral arteriovenous malformations
  • Intracerebral hemorrhage
  • Intracranial hemorrhage
  • Outcome
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Choi, J. H., Mast, H., Sciacca, R. R., Hartmann, A., Khaw, A. V., Mohr, J. P., ... Stapf, C. (2006). Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation. Stroke, 37(5), 1243-1247. https://doi.org/10.1161/01.STR.0000217970.18319.7d

Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation. / Choi, Jae H.; Mast, Henning; Sciacca, Robert R.; Hartmann, Andreas; Khaw, Alexander V.; Mohr, Jay P.; Sacco, Ralph L; Stapf, Christian.

In: Stroke, Vol. 37, No. 5, 01.05.2006, p. 1243-1247.

Research output: Contribution to journalArticle

Choi, Jae H. ; Mast, Henning ; Sciacca, Robert R. ; Hartmann, Andreas ; Khaw, Alexander V. ; Mohr, Jay P. ; Sacco, Ralph L ; Stapf, Christian. / Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation. In: Stroke. 2006 ; Vol. 37, No. 5. pp. 1243-1247.
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AU - Mohr, Jay P.

AU - Sacco, Ralph L

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