Epidemiology and natural history of arteriovenous malformations

Abstract

<jats:p>The epidemiology and natural history of cerebral arteriovenous malformations (AVMs) remains incompletely elucidated. Several factors are responsible. With regard to the incidence and prevalence of AVMs, the results of prior studies have suffered because of the retrospective design, the use of nonspecific ICD-9 codes, and a focus on small genetically isolated populations. Recent data from the New York Islands AVM Hemorrhage Study, an ongoing, prospective, population-based survey determining the incidence of AVM-related hemorrhage and the associated rates of morbidity and mortality in a zip code–defined population of 10 million people, suggests that the AVM detection rate is 1.21/100,000 person-years (95% confidence interval [CI] 1.02–1.42) and the incidence of AVM-hemorrhage is 0.42/100,000 person-years (95% CI 0.32–0.55). Contemporaneous data from the Northern Manhattan Stroke Study, a prospective, longitudinal population-based study of nearly 150,000 patients in which the focus is to define the incidence of stroke, suggest the crude incidence for first-ever AVM-related hemorrhage to be 0.55/100,000 person-years (95% CI 0.11–1.61). Efforts are ongoing to study the natural history of both ruptured and unruptured AVMs in these datasets to examine the relevance of prior studies of patients selected for conservative follow up in Finland. In addition, data are being gathered to determine whether risk factors for future hemorrhage, which have previously been established in small case series, are valid when applied to whole populations. Together, these data should help inform therapeutic decisionmaking.</jats:p>

Natural history of brain arteriovenous malformations: a systematic review

“…17,36 After hemorrhage, the next most common presenting feature is seizures, occurring 30% of the time, followed by headaches, which were reported to occur 5%-14% of the time by only 2 cases series. These data vary considerably, probably depending on their geographic origin; an initial hemorrhage rate of 71% was found for the Nordic countries of Sweden, the Netherlands, and Finland; and rates of 42% and 52% were found for North America and Western Europe.…”

Multiple Low Flow Vascular Malformation with Phleboliths – A Case Report

“…Angiography is also a useful modality for defining extent of disease, especially when identifying deep or small VMs, such as intracranial sinus pericranii or gastrointestinal VM. [12][13][14][15][16][17][18][19][20] In the present case, phleboliths were seen on plain radiography and were suggestive of vascular anomaly with slow flow rate. Whereas, by direct phlebography the lesion was seen draining the regional vein.…”

Multiple Symptomatic Cerebral Arteriovenous Malformations in a Patient with HIV

“…7,8 HIV-associated cerebral vasculopathy was proposed as an important mechanism of stroke in the absence of a known cause, possibly related to deposition of a circulating immune complex or a direct toxic effect on the vascular endothelium. 9 Kure et al We only found 1 case report by Wolf et al 12 describing a 53-year-old patient with HIV infection who had a right Rolandic cerebral AVM leading to recurring focal seizures. There was a single draining vein with a large varix and a flow-related arterial aneurysm.…”