Clinical Outcome After First and Recurrent Hemorrhage in Patients With Untreated Brain Arteriovenous Malformation

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

doi:10.1161/01.str.0000217970.18319.7d

Cited by 183 publications

(118 citation statements)

References 23 publications

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“…The observation that most patients can recover after a hemorrhage from an intracranial DAVF is similar to that reported in patients with hemorrhage from parenchymal arteriovenous malformations. 2 This prognosis is decidedly better than that reported for ruptured aneurysms. It is possible that our series reflects patients evaluated and treated at 2 tertiary referral centers with a referral bias, and we may have missed patients who were not transferred because of very poor clinical condition.…”

Section: Discussionmentioning

confidence: 76%

Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

Daniels

Vellimana

Zipfel

et al. 2013

FOC

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Object In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage. Methods A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

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Section: Discussionmentioning

confidence: 76%

Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

Daniels

Vellimana

Zipfel

et al. 2013

FOC

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“…Large AVMs with deep venous drainage in eloquent brain regions may not be amenable to therapy [49]. Adding to the calculus regarding treatment is the fact that in the New York Islands AVM study, recurrent AVM hemorrhage did not alter clinical outcome and had a low mortality [54,55].…”

Section: Potential Treatments For Iphmentioning

confidence: 99%

Hemorrhagic Stroke in Children

Jordan

Hillis

2007

Pediatric Neurology

112

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Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research and potential therapies are also discussed.

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“…5 Second, the morbidity associated with arteriovenous malformations (AVM) bleeding may be less than previously thought. 6,7 Third, the risk of neurological injury after treatment of unruptured BAVM may be greater than previously described. [8][9][10] A randomized trial of unruptured brain arteriovenous malformations (ARUBA) was designed to compare the risk of observation versus prophylactic intervention for patients diagnosed with unruptured BAVM.…”

mentioning

confidence: 96%

The Risk of Stroke or Clinical Impairment After Stereotactic Radiosurgery for ARUBA-Eligible Patients

Pollock

Link

Brown

2013

Stroke

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Background and Purpose-The best management of patients with unruptured brain arteriovenous malformations (BAVM) is controversial. In this study, we analyzed the stroke rate and functional outcomes of patients having stereotactic radiosurgery (SRS) for unruptured BAVM using the same eligibility criteria and primary end points as the ARUBA trial. Methods-Retrospective observational study of 174 ARUBA-eligible patients having SRS from 1990 to 2005. Results-The median follow-up after SRS was 64 months. Fifteen patients (8.7%) had a hemorrhagic stroke at a median of 21 months after SRS. Six patients (3.5%) had a focal neurological deficit and 4 patients died (2.3%). The risk of stroke or death was 10.3% at 5 years and 11.5% at 10 years. Twelve additional patients (6.9%) had a focal neurological deficit from either radiation-related complications (n=7) or subsequent resection (n=5). The risk of patients' having clinical impairment (modified Rankin Score ≥2) was 8.4% at 5 years and 12.0% at 10 years. Increasing BAVM volume was associated with both stroke or death (hazard ratio=1.06; 95% confidence interval, 1.0-1.11; P=0.04) and clinical impairment (hazard ratio=1.06; 95% confidence interval, 1.01-1.09; P=0.01). The 10-year risk of stroke or death and clinical impairment for patients with BAVM ≤5.6 cm 3 was 5% and 4%, respectively. Conclusions-The observed risk of stroke or death after SRS was approximately 2% per year for the first 5 years after SRS, declining to 0.2% annually for years 6 to 10. Patients with small volume BAVM may benefit from SRS compared with the natural history of unruptured BAVM over the planned follow-up interval of the ARUBA trial (5-10 years). (Stroke. 2013;44:437-441.)

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Clinical Outcome After First and Recurrent Hemorrhage in Patients With Untreated Brain Arteriovenous Malformation

Cited by 183 publications

References 23 publications

Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

Hemorrhagic Stroke in Children

The Risk of Stroke or Clinical Impairment After Stereotactic Radiosurgery for ARUBA-Eligible Patients

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