Acute fatal hemorrhage from previously undiagnosed cerebral arteriovenous malformations in children: a single-center experience

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The most significant adverse outcome of intracranial hemorrhage from an arteriovenous malformation (AVM) is death. This study reviews a single-center experience with pediatric AVMs to quantify the incidence and characterize clinical and radiographic factors associated with sudden death from the hemorrhage of previously undiagnosed AVMs in children.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A single-center database review of the period from 2006 to 2017 identified all patients with a first-time intracranial hemorrhage from a previously undiagnosed AVM. Clinical and radiographic data were collected and compared between patients who survived to hospital discharge and those who died at presentation.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 57 patients (average age 10.8 years, range 0.1–19 years) presented with first-time intracranial hemorrhage from a previously undiagnosed AVM during the study period. Of this group, 7/57 (12%) patients (average age 11.5 years, range 6–16 years) suffered hemorrhages that led directly to their deaths. Compared to the cohort of patients who survived their hemorrhage, patients who died were 4 times more likely to have an AVM in the posterior fossa. No clear pattern of antecedent triggering activity (sports, trauma, etc.) was identified, and 3/7 (43%) experienced cardiac arrest in the prehospital setting. Surviving patients were ultimately treated with resection of the AVM in 42/50 (84%) of cases.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Children who present with hemorrhage from a previously undiagnosed intracranial AVM had a 12% chance of sudden death in our single-institution series of pediatric cerebrovascular cases. Clinical triggers of hemorrhage are unpredictable, but subsequent radiographic evidence of a posterior fossa AVM was present in 57% of fatal cases, and all fatal cases were in locations with high risk of potential herniation. These data support a proactive, aggressive approach toward definitive treatment of AVMs in children.</jats:p></jats:sec>

Predictors of Cerebral Arteriovenous Malformation Mortality: A Single-center, Five-year Retrospective Study

“…The mortality in the adult population is similar to that reported by Hillman, et al 26 as well as other literature, such as Rinaldi et al 21 who reported 13.46% mortality rate and other studies with a range from 10 to 15%. 17,20 However, the mortality in the pediatric population is vastly different from that of the literature, being 33.3% in our study and 12% in a study published by Riordan, et al 27 Finally, we note that hemorrhage is an important mortality factor; which was the most common presentation in our sample; occurring in 24 out of 30 pediatric patients, while in adults, it was present in 23 out of 50.…”

“…30,31 32 The aforementioned has been highlighted as a poor prognostic factor in both children and adults, without being correctly demonstrated by the literature. [30][31][32][33][34][35][36] In our study we found a IJMS high prevalence of symptom onset in non-laboral hours, but a future and more specific analysis focusing on this exact variable is necessary.…”

Ruptured Arteriovenous Malformation Anterior to the Brainstem to a Child with Subsequent Spontaneous Thrombosis: Case Report and Literature Review

“…Children harboring a previously undiagnosed intracranial AVM and present with a hemorrhagic ictus, are reported to suffer a 12% chance of sudden death [16]. Subsequent diagnostic imaging workup verified that a posterior fossa AVM was present in 57% of fatal cases, and all of them were associated with malformations located in areas with an associated increased risk of potential herniation, as in our case.…”

Effect of Cinepazide Maleate on Serum Inflammatory Factors of ICU Patients with Severe Cerebral Hemorrhage after Surgery

“…If patients with surgical indications have more serious condition or their secondary cause is found, surgical treatment will be adopted to mainly reduce intracranial pressure, remove hematoma, and save the life of patients. In addition, patients need to control blood pressure to reach the standard and be stable for life [ 16 ]. The prognosis of the disease is often related to the amount of bleeding, bleeding sites, and complications.…”