Effect of Age on Clinical and Morphological Characteristics in Patients With Brain Arteriovenous Malformation

Abstract

Background and Purpose-The goal of this work was to determine the effect of age at initial presentation on clinical and morphological characteristics in patients with brain arteriovenous malformation (AVM). Methods-The 542 consecutive patients from the prospective Columbia AVM database (meanϮSD age, 34Ϯ15 years) were analyzed. Univariate statistical models were used to test the effect of age at initial presentation on clinical (AVM hemorrhage, seizures, headaches, neurological deficit, other/asymptomatic) and morphological (AVM size, venous drainage pattern, AVM brain location, concurrent arterial aneurysms) characteristics. Results-Hemorrhage was the presenting symptom in 46% (nϭ247); 29% (nϭ155) presented with seizures, 13% (nϭ71) with headaches, 7% (nϭ36) with a neurological deficit, and 6% (nϭ33) without AVM-related symptoms. Increasing age correlated positively with intracranial hemorrhage (Pϭ0.001), focal neurological deficits (Pϭ0.007), infratentorial AVMs (PϽ0.001), and concurrent arterial aneurysms (PϽ0.001); an inverse correlation was found with seizures (PϽ0.001), AVM size (Pϭ0.001), and lobar (PϽ0.001), deep (Pϭ0.008), and borderzone (Pϭ0.014) location. No age differences were found for sex, headache, asymptomatic presentation, and venous drainage pattern. Conclusions-Our data suggest a significant interaction of patient age and clinical and morphological AVM features and argue against uniform AVM characteristics across different age classes at initial presentation. In particular, AVM patients diagnosed at a higher age show a higher fraction of AVM hemorrhage and are more likely to harbor additional risk factors such as concurrent arterial aneurysms and small AVM diameter. Longitudinal population-based AVM data are necessary to confirm these findings.

Management of Stroke in Infants and Children

“…More than three fourths of the AVMs that become symptomatic in children present with hemorrhage, 338 -340 typically in the supratentorial region, where 80% of the AVMs occur. 339,341 In the remaining children, the AVM is discovered during an evaluation for seizures, headaches, and focal neurological deficits that are not due to an obvious hemorrhage. Occasionally, individuals present with isolated intracranial hypertension that mimics pseudotumor cerebri.…”

“…The occurrence of an aneurysm and an AVM in the same individual is more common in children than in adults. 341 Establishing the cause of the bleeding is important because the cause affects the treatment approach, the prognosis, and the stroke recurrence risk. Generally, Ն1 possible risk factors for hemorrhage can be identified if a thorough diagnostic evaluation is completed.…”

Surgical Treatment of Non-ruptured Giant Occipital Arteriovenous Malformations With Frequent Migraine-Like Headache-Two Case Reports-

“…In fact, patients with AVM identified at higher age show a higher incidence of AVM hemorrhage. 18) The present cases of giant occipital AVM were characterized by recent development of visual field defects and abundant participation of dural feeders. Moreover, both patients noticed gradual visual field cut.…”

Periventricular Location as a Risk Factor for Hemorrhage and Severe Clinical Presentation in Pediatric Patients with Untreated Brain Arteriovenous Malformations

“…4 In contrast to adult patients, children with BAVMs are more likely to present initially with ICH, while the overall annual hemorrhage rate for pediatric BAVM does not exceed that of adults. 5 A long-term follow-up study revealed that childhood presentation may provide relative protection against subsequent ICH.…”