Prevalence of adults with brain arteriovenous malformations: a community based study in Scotland using capture-recapture analysis

Al‐Shahi, Rustam; Fang, Jinghuan; Lewis, Steff; Warlow, Charles

doi:10.1136/jnnp.73.5.547

Cited by 156 publications

(79 citation statements)

References 20 publications

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“…8 The prevalence of these lesions is 1 per 1000 adults, 144 and their incidence is 1 per 100,000 per year. 7 The most common manifestation of an AVM is an intracranial hemorrhage, accounting for as many as 50% of initial presentations. 145 AVMs may also cause headaches, seizures, or focal neurological deficits.…”

Section: Arteriovenous Malformationsmentioning

confidence: 99%

Management of incidentally discovered intracranial vascular abnormalities

Chalouhi¹,

Dumont²,

Randazzo³

et al. 2011

FOC

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With the widespread use of brain imaging studies, neurosurgeons have seen a marked increase in the number of incidental intracranial lesions, including vascular abnormalities. Specifically, the detection of incidentally discovered aneurysms, arteriovenous malformations, cavernous angiomas, developmental venous anomalies, and capillary telangiectasias has increased. The best management strategy for most of these lesions is controversial. Treatment options include observation, open surgery, endovascular procedures, and radiosurgery. Multiple factors should be taken into account when discussing treatment indications, including the natural history of the disease and the risk of the treatment. In this article, the authors focus on the natural history of these lesions and the risk of the treatment, and they give recommendations regarding the most appropriate management strategy based on the current evidence in the literature and their experience with intracranial vascular abnormalities.

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Section: Arteriovenous Malformationsmentioning

confidence: 99%

Management of incidentally discovered intracranial vascular abnormalities

Chalouhi¹,

Dumont²,

Randazzo³

et al. 2011

FOC

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“…[1] Large autopsy series have shown the incidence of AVMs to be between 0.04% and 0.52%. [2,3] Brain AVMs are the leading cause of intracerebral hemorrhage in the young population. They are responsible for 3% of strokes in young adults and 9% of subarachnoid hemorrhages (SAH).…”

Section: Introductionmentioning

confidence: 99%

Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization

Janamiri¹,

Arjmand²,

Torkian³

2017

AJMCR

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Introuction: Brain Arteriovenous malformations (AVMs) are the leading cause of intracerebral hemorrhage in the young population. We set out to determine angiographic features of AVMs in pre-operative setting as well as angiographic and neurological and clinical assessment of these AVMs after treatment with either microsurgical approach or angio-embolization. Materials and Methods: From February 2011 to January 2016, 25 patients with cerebral AVMs were admitted to Shohada Tajrish Hospital. Patients underwent angiographic evaluation for AVM grading based on Spetzler Martin grading system. Also, patient's neurological status was recorded. Based on Spetzler Martin score and AVM size, patients underwent either microsurgical approach or angioembolization. Post-operatively, early and long-term neurological examination was performed and obliteration rate was assessed by post-operative imaging study. Results: There were 18 male and 7 female patients with mean age of 42.2 years who presented with cerebral hemorrhage followed by isolated new-onset seizure, progressive new focal neurological deficit and severe new-onset headache in decreasing manner. Seizure was significantly higher in patients with unruptured AVMs (P value <0.01). Angiographic study based on Spetzler-Martin grading system showed that most of the patients had grade 3 (32%), followed by grade 4 (28%), grade 2 (28%), grade 5 (8%) and grade 1 (4%). Most AVMs were eloquent with superficial drainage and small sized. Based on AVM size, trend for operation type in small and medium sized AVMs was microsurgical approach followed by angio-embolization. On the other hand, most patients with large-sized AVMs underwent angio-embolization followed by microsurgical approach. Early post-operative examination revealed more new neurological deficit in angio-embolization than microsurgery treated patients (P value <0.05). Improvement in neurological status was observed in microsurgery treated cases compared to angio-embolization (P value <0.05). Long-term follow up showed similar promising results in patients treated with microsurgery which was statistically significant (P value <0.05). Post-operative imaging study demonstrates complete obliteration in 12 patients out of 15 patients (80%) who underwent microsurgical approach. Complete obliteration was observed in 4 cases out of 10 patients (40%) who were treated with angio-embolization. (P value < 0.05). Conclusion: Although results of this study showed better results with microsurgical approach, choosing best treatment option for patients suffering from symptomatic AVMs depends on imaging studies, pre-operative grading and individual-based selection.

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“…Brain AVMs have a population prevalence of 10-18 per 100,000 adults [3,7], and a new detection rate of ~1.3 per 100,000 person-years [58]. The basic morphology is of a vascular mass, called the nidus, that directly shunts blood between the arterial and venous circulations without a true capillary bed.…”

Section: Abstract Angiogenesis; Inflammation; Vascular Malformationsmentioning

confidence: 99%

“…Therefore, given the total AVM population prevalence of 10-18 per 100,000 adults [3,7], the fraction of HHT-AVMs in large referral series should be approximately 5-10%. Interestingly, HHT accounts for less than 1% of the UCSF [31] and Columbia [39] AVM databases (unpublished data), suggesting that systematic underestimation of undiagnosed HHT may occur in the large referral cohorts.…”

Section: Mendelian Diseasementioning

confidence: 99%

“…Five of 31 cases (assuming 26 cases included in the association analysis had no family history) had affected siblings, yielding a sibling recurrence risk (K s ) of 16%. Given a population risk of AVM (K) of 18 per 100,000 (0.018%) [3], the excess sibling risk (λ sibling = K sibling /K) is estimated to be 889 (16% / 0.018%). As a sensitivity analysis, we calculated λ sibling varying the recurrence risk to siblings from 0.01% to 50% and assuming a population prevalence of AVM of 0.018%.…”

Section: Familial Aggregrationmentioning

confidence: 99%

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Genetic considerations relevant to intracranial hemorrhage and brain arteriovenous malformations

Kim

Marchuk

Pawlikowska

et al.

Acta Neurochirurgica Supplementum

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SUMMARYBrain arteriovenous malformations (AVM) cause intracranial hemorrhage (ICH), especially in young adults. Molecular characterization of lesional tissue provides evidence for involvement of both angiogenic and inflammatory pathways, but the pathogenesis remain obscure and medical therapy is lacking. Abnormal expression patterns have been observed for proteins related to angiogenesis (e.g., VEGF, Angiopoietin-2, MMP-9), and inflammation (e.g., IL-6 and MPO). Macrophage and neutrophil invasion has also been observed in the absence of prior ICH. Candidate gene association studies have identified a number of germline variants associated with clinical ICH course and AVM susceptibility. A single nucleotide polymorphism (SNP) in ALK-1 is associated with AVM susceptibility, and SNPs in IL-6, TNF-α and APOE are associated with AVM rupture. These observations suggest that even without a complete understanding of the determinants of AVM development, the recent discoveries of downstream derangements in vascular function and integrity may offer potential targets for therapy development. Further, biomarkers can now be established for assessing ICH risk. Finally, these data will generate hypotheses that can be tested mechanistically in model systems, including surrogate phenotypes, such as vascular dysplasia and/or models recapitulating the clinical syndrome of recurrent spontaneous ICH. Keywords angiogenesis; inflammation; vascular malformationsBrain arteriovenous malformations (AVM) represent a relatively infrequent but important source of neurological morbidity in relatively young adults [4]. Brain AVMs have a population prevalence of 10-18 per 100,000 adults [3,7], and a new detection rate of ~1.3 per 100,000 person-years [58]. The basic morphology is of a vascular mass, called the nidus, that directly shunts blood between the arterial and venous circulations without a true capillary bed. There is usually high flow through the feeding arteries, nidus and draining veins. The nidus is a

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Prevalence of adults with brain arteriovenous malformations: a community based study in Scotland using capture-recapture analysis

Cited by 156 publications

References 20 publications

Management of incidentally discovered intracranial vascular abnormalities

Management of incidentally discovered intracranial vascular abnormalities

Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization

Genetic considerations relevant to intracranial hemorrhage and brain arteriovenous malformations

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