Purpose: We sought to evaluate the long-term functional outcomes and identify the potential risk factors for rebleeding in patients with brain stem cavernous malformations (BCMs) who presented with hemorrhages and were surgically or conservatively treated and prospectively monitored. Methods: From January 1990 to July 2015, we included patients with first hemorrhagic episodes secondary to single BCMs. Modified Rankin score (mRS) was used for neurological status assessment. Univariate and multivariate regression statistics were used to identify the risk factors for rebleeding. Results: A total of 99 patients with BCMs hemorrhages were included (59 [59.6%] women, mean age 37± 13 years). As initial treatments, 37 patients (37.4%) underwent surgery and 62 (62.6%) received conservative treatment. The median follow-up was 3.33 years (interquartile range 1.16-7 years; 408.3 patient/years). The rebleeding rate by patient/year was 10% in conservatively treated patients. Deterioration was significantly more frequent in patients with rebleeding (p = 0.0001). At the end of the follow-up, the mRS were favorable in 49 patients (65.3%) without rebleeding, whereas only 8 (33.3%) with rebleeding evolved to favorable outcomes (p = 0.006). Lesion size >18 mm (hazards ratio, HR 3.34, 95% CI 1.54-7.26; p = 0.0001) and ventral location or crossing the brain stem's midpoint (HR 2.5, 95% CI 1.14-5.46; p = 0.022) were associated with a major risk of rebleeding in the univariate analysis, but only a lesion >18 mm remained statistically significant (HR 2.7, 95% CI 1.2-6.21; p = 0.016) in the multivariate analysis. Conclusion: A lesion size >18 mm was the principal factor associated with hemorrhage recurrence. The overall functional outcome was good. However, significant morbidity was attributable to rebleeding.

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Intracranial aneurysms uncommonly present with ischemic stroke. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients are absent. We present the clinical outcome and radiological characteristics of three patients with spontaneous thrombosis of intracranial aneurysms as a cause of ischemic stroke. This information is relevant given the possible benign history in terms of stroke recurrence and risk of bleeding.

Brainstem cavernous malformation (BCM) account for 8-22% of all intracranial cavernomas. Currently, they can be treated microsurgically or conservative but it is still difficult to choose the best treatment for each patient. The main objective of our series was to evaluate the long-term functional outcome and recurrence in patients with BCM treated with conservative or surgical treatments. Hypothesis: We assessed the hypothesis that surgical and conservative treatments are associated with different functional outcome and re-hemorrhage rate in long-term follow-up. Methods: In this non-randomized, clinical series, we compared the clinical and radiological findings of patients with their first hemorrhage secondary to confirmed BCM, treated in a tertiary neurological center, during a twenty five- year period. Treatment of each patient was selected by the attending physician and consisted of either conservative or surgical evacuation of BCM. The primary end-points were recurrent hemorrhage and functional outcome. Favorable prognosis was defined as modified Rankin scale (mRs) of 0 to 2. Results: From January of 1990 to July of 2015; 99 patients with BCM hemorrhage were treated (59 [59,6%] female; mean age 37± 13 years). 37 patients (37,4%) were surgically treated and 62 (62,6%) received conservative treatment. During the follow-up; 20 patients in the medical group (median time of recurrence: 34,5 months; IQR: 13,75-93) and 4 patients in the surgical group (median time of recurrence: 22 months; IQR: 9-46,5) had a recurrence (OR: 0,255; 95% IC: 0,079-0,817), with a cumulative incidence of 5,1 per 100 years-person and 3,96 per 100 years-person respectively. Because of rebleeding, 11 patients of the conservative group were taken to surgery and 3 of the surgical group were to required re-intervention. At the end of follow-up (median: 51 months; IQR: 19-104) 51 patients remained in the conservative group and 28 (54,9%) had a favorable mRs. 48 patients remained in the surgical group and 27 (56,2%) had a favorable mRs (OR:0,94 95% IC: 0,42-2,09). Conclusion: Despite a significant high recurrent hemorrhage rate was observed in conservative treated patients, we did not found difference in clinical outcome between both groups of patients with BCM.

Background: Transverse sinuses (TS) are frequently asymmetric. Hypoplasia or aplasia of TS is a common anatomical variation, right TS is dominant in 61% of cases. The relationship between hypoplastic TS and cerebral venous thrombosis is not well established. Hypothesis: Transverse sinus hypoplasia is a predisposing factor for ipsilateral transverse sinus thrombosis Methods: We retrospectively evaluated 27 confirmed cases with isolated transverse sinus thrombosis and 54 age-and-sex matched controls, treated in a Neurological tertiary center from 2010 to 2015. A stroke neurologist and a neuroradiologist measured TS using an MRI sequence (Inhance 3D Inflow IR); interrater reliability was calculated using Bland-Altman plots. Hypoplasia was defined as a transverse sinus diameter less than 50% of the cross-sectional diameter of the lumen of the distal superior sagittal sinus. Univariate analysis was performed to evaluate the association between transverse sinus hypoplasia (TSh) and thrombosis. Results: There was a good inter-rater reliability (p=0.55 on the Bland-Altman plot by ANOVA test). There were a total of 45 left hypoplastic transverse sinuses (TS) (19 [70.4%] cases vs. 26 [48.1%] controls), and 16 right hypoplastic TS (11 [40.7%] cases vs. 5 [9.3%] controls). Ipsilateral thrombosis was present in 9 (33.3%) right and 15 (55.5%) left hypoplastic transverse sinuses. Transverse sinus thrombosis was more likely to be present when associated with left TSh (RR 2.57, 95% CI 1.17-5.69; p=0.001), than right TSh and ipsilateral thrombosis (RR 0.15, 95% CI 0.04-0.57; p<0.001). Conclusion: Isolated transverse sinus hypoplasia might be a predisposing factor for ipsilateral transverse sinus thrombosis.