Angioarchitectural Risk Factors for Hemorrhage and Clinical Long-Term Outcome in Pediatric Patients with Cerebral Arteriovenous Malformations

Reitz, Matthias; Spreckelsen, Niklas von; Vettorazzi, Eik; Burkhardt, Till; Grzyska, Ulrich; Fiehler, Jens; Schmidt, Nils Ole; Westphal, Manfred; Regelsberger, Jan

doi:10.1016/j.wneu.2016.02.050

Cited by 30 publications

(25 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the current study, the maximum diameter of bAVMs was the independent predictor for rupture. In accordance with the present results, previous studies have illustrated that the incidence of subsequent hemorrhage increased with decreasing the size of lesions in untreated bAVMs [39,40]. A small size of bAVMs (<3 cm) were more likely to present with bleeding compared to the larger lesions.…”

Section: Disease Markerssupporting

confidence: 92%

Homocysteine Level and Risk of Hemorrhage in Brain Arteriovenous Malformations

Zeng

Lin

et al. 2021

Disease Markers

View full text Add to dashboard Cite

Objective. We aimed to investigate the risk factors associated with hemorrhage and clarify the relation of homocysteine (Hcy) with brain arteriovenous malformations (bAVMs). Method. We retrospectively reviewed bAVM patients from Beijing Tiantan Hospital between January 2019 and December 2019. Clinical and laboratory variables were analyzed in enrolled patients with bAVMs. Potential predictors associated with hemorrhage were evaluated by logistic regression analysis. Results. A total of 143 bAVM patients were identified in the study, including 69 unruptured and 74 ruptured cases. Patients with hemorrhage were less likely to have hyperhomocysteinemia ( P = 0.023 ). Logistic regression analysis showed that increased maximum diameter of bAVM lesions (odds ratio (OR) 0.634, 95% confidence intervals (CI) 0.479-0.839; P = 0.001 ) and serum Hcy level (OR 0.956, 95% CI 0.920-0.993; P = 0.021 ) were associated with lower risk of hemorrhage in bAVMs. Conclusion. The present study provided evidence regarding the association between serum Hcy and hemorrhage in patients with bAVMs. Higher Hcy level was correlated with a lower risk of rupture. Detection of factors for subsequent hemorrhage is necessary to develop therapeutic strategies for bAVMs preferably.

show abstract

Section: Disease Markerssupporting

confidence: 92%

Homocysteine Level and Risk of Hemorrhage in Brain Arteriovenous Malformations

Zeng

Lin

et al. 2021

Disease Markers

View full text Add to dashboard Cite

show abstract

“…442,443 Management of deep lesions, including thalamic and brainstem AVMs, is higher risk but can still provide reasonable outcomes in selected cases (54% radiographic cure). 439,441,442,444,445 Higher-grade lesions have lower rates of successful treatment (≈35%) with radiosurgery. 446 In all cases, long-term follow-up, including posttreatment DSA, is critical because recurrence rates are as high as 11%.…”

Section: Genetic Screeningmentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

490

515

View full text Add to dashboard Cite

Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

show abstract

“…This finding is within the range of other reported series of AVM hemorrhage-related mortality, but is higher than reported mortality rates for pediatric intracranial hemorrhage from any cause, and is unique in its specificity for focusing on the population of pediatric patients and those uniquely characterized as experiencing first-time bleeds from undiagnosed AVMs. 6,12,15,17 As such, this study may provide a useful benchmark for clinicians in calculating risk of death from initial hemorrhage in children.…”

Section: General Prevalence Of Sudden Death From First-time Hemorrhagmentioning

confidence: 99%

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

Riordan¹,

Orbach

Smith³

et al. 2018

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEThe 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.METHODSA 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.RESULTSA 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.CONCLUSIONSChildren 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.

show abstract

Angioarchitectural Risk Factors for Hemorrhage and Clinical Long-Term Outcome in Pediatric Patients with Cerebral Arteriovenous Malformations

Cited by 30 publications

References 41 publications

Homocysteine Level and Risk of Hemorrhage in Brain Arteriovenous Malformations

Homocysteine Level and Risk of Hemorrhage in Brain Arteriovenous Malformations

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

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

Contact Info

Product

Resources

About