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 language | English |
|---|---|
| Pages (from-to) | 1243-1247 |
| Number of pages | 5 |
| Journal | Stroke |
| Volume | 37 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2006 |
| Externally published | Yes |
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Keywords
- Cerebral arteriovenous malformations
- Intracerebral hemorrhage
- Intracranial hemorrhage
- Outcome
- Subarachnoid hemorrhage
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Neuroscience(all)
Cite this
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 journal › Article
}
TY - JOUR
T1 - Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation
AU - Choi, Jae H.
AU - Mast, Henning
AU - Sciacca, Robert R.
AU - Hartmann, Andreas
AU - Khaw, Alexander V.
AU - Mohr, Jay P.
AU - Sacco, Ralph L
AU - Stapf, Christian
PY - 2006/5/1
Y1 - 2006/5/1
N2 - 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.
AB - 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.
KW - Cerebral arteriovenous malformations
KW - Intracerebral hemorrhage
KW - Intracranial hemorrhage
KW - Outcome
KW - Subarachnoid hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=33646710866&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33646710866&partnerID=8YFLogxK
U2 - 10.1161/01.STR.0000217970.18319.7d
DO - 10.1161/01.STR.0000217970.18319.7d
M3 - Article
C2 - 16614321
AN - SCOPUS:33646710866
VL - 37
SP - 1243
EP - 1247
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 5
ER -