Racial Associations with Hemorrhagic Presentation in Cerebral Arteriovenous Malformations

Yang, Wuyang; Caplan, Justin M.; Ye, Xiaobu; Wang, Joanna Y.; Braileanu, Maria; Rigamonti, Daniele; Colby, Geoffrey P.; Coon, Alexander L.; Tamargo, Rafael J.; Huang, Judy

doi:10.1016/j.wneu.2015.03.050

Cited by 26 publications

(15 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 For AVM, the rupture risk of nonwhite races, including Asian, is reported to be 3.09-fold higher than that in white people. 13 Another possible factor underlying the relatively low rate of CVD-unrelated hemorrhage such as PIH in the present study is the Japanese obstetric medical care system, which is helpful in the early detection and treatment of obstetric complications. The practice in Japan is for pregnant women to be regularly checked every 2 weeks after 26 weeks' gestation and every week after 36 weeks by blood pressure measurement and urine testing.…”

Section: Hemorrhagic Strokementioning

confidence: 80%

See 1 more Smart Citation

Strokes Associated With Pregnancy and Puerperium

Yoshida

Takahashi

Takenobu

et al. 2017

Stroke

View full text Add to dashboard Cite

Background and Purpose-The incidence and cause of strokes associated with pregnancy and the puerperium are still not fully understood. The aim of this study was to characterize pregnancy-related strokes in Japan using a large-scale survey with current imaging techniques. Methods-A retrospective analysis was conducted based on clinical chart reviews in 736 stroke teaching hospitals certified by the Japan Stroke Society between 2012 and 2013, using a web-based questionnaire requesting the detailed clinical course without any personally identifying information. The collection rate of this questionnaire was 70.5%, with 151 pregnancy-associated strokes extracted. Results-Hemorrhagic strokes were observed in 111 cases (73.5%), ischemic strokes in 37 (24.5%), and mixed type in 3 cases (2.0%). The estimated incidence of pregnancy-associated stroke was 10.2 per 100 000 deliveries. Major causes of hemorrhage were aneurysm (19.8%), arteriovenous malformation (17.1%), pregnancy-induced hypertension (11.7%), and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) (8.1%). Preexisting cerebrovascular diseases responsible for hemorrhage were detected in 59 cases (53.1%). Among the ischemic strokes, 28 (75.7%) were arterial and 9 (24.3%) were venous infarctions. The most frequent cause of arterial infarctions was reversible cerebral vasoconstriction syndrome. Hemorrhagic stroke showed much poorer prognosis than ischemic stroke. Conclusions-The incidence of pregnancy-associated stroke in Japan did not seem higher than that in other Asian and Western countries. The proportion of hemorrhagic stroke among Japanese women was much higher than that in white women. Preexisting cerebrovascular diseases and reversible cerebral vasoconstriction syndrome play a key role in hemorrhagic and ischemic stroke, respectively.

show abstract

Section: Hemorrhagic Strokementioning

confidence: 80%

“…In addition, racial and ethnic differences in stroke subtypes have been well recognized between Western and Asian populations. 3,6,9,[11][12][13] The aim of the present study was to elucidate the incidence and causes of pregnancy-associated strokes in Japanese women on a large scale in the era of magnetic resonance imaging (MRI).…”

mentioning

confidence: 99%

Strokes Associated With Pregnancy and Puerperium

Yoshida

Takahashi

Takenobu

et al. 2017

Stroke

View full text Add to dashboard Cite

show abstract

“…In this study we present a cohort of 90 pediatric patients with a confirmed diagnosis of intracranial AVM and compared the natural history, posttreatment hemorrhagic risk, and functional prognosis across different treatment modalities. Previous studies have established the risk of hemorrhagic presentation to be 30%-82%, 11,14,27,28,53 and the natural history of hemorrhage in AVMs is 1.9%-4.61% in the general population. 6,7,10,11,15,18 In contrast, the natural history of AVMs in pediatric patients is underreported in the existing literature.…”

Section: Discussion Hemorrhagic Risk Of Avmsmentioning

confidence: 99%

“…2%-40.6% 3,8,16 of all patients who hemorrhage develop residual neurological deficits. Despite an established annual hemorrhagic risk of 1.9%-4.61% in the general population, 1,7,10,45,53 the risk of hemorrhage in pediatric patients is not entirely understood. Nevertheless, the high cumulative hemorrhagic risk, given the long life expectancy in pediatric patients, warrants definitive treatment of the AVM to prevent hemorrhages later in life.…”

mentioning

confidence: 99%

Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

Yang¹,

Anderson-Keightly²,

Westbroek³

et al. 2016

PED

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Compared with the general population, the specific natural history of arteriovenous malformations (AVMs) in pediatric patients is less well understood. Furthermore, few pediatric studies have compared posttreatment hemorrhagic risk and functional outcome across different treatment modalities. The objective of this study was to elucidate these points. METHODS The authors retrospectively reviewed all pediatric patients with AVMs evaluated at their institution between 1990 and 2013. The AVM natural history was represented by hemorrhagic risk during the observation period. For treated patients, the observation period was defined as the interval between diagnosis and treatment. Posttreatment hemorrhagic risk and functional outcomes were also assessed. RESULTS A total of 124 pediatric patients with AVMs were evaluated, and 90 patients (72.6%) were retained through follow-up. The average patient age was 13.3 ± 3.8 years, with a mean follow-up period of 9.95 years. The overall AVM obliteration rate was 59.7%. Radiosurgery had an obliteration rate of 49.0%. Thirteen patients were managed conservatively. Four patients under observation hemorrhaged during a total interval of 429.4 patient-years, translating to an annual risk of 0.9%. Posttreatment hemorrhagic risk by treatment modalities were categorized as follows: surgery ± embolization (0.0%), radiosurgery ± embolization (0.8%), embolization alone (2.8%), surgery + radiosurgery ± embolization (3.5%), and observation (0.8%). A significantly higher risk of posttreatment hemorrhage was observed for patients with hemorrhagic presentation (p = 0.043) in multivariate analysis. Seizure presentation, frontal lobe location, nonheadache presentation, and treatment modality were significantly associated with increased risk of poor functional outcomes. CONCLUSIONS In this study of pediatric patients with AVMs, the natural history of hemorrhage was relatively low at 0.9%. Resection remained the optimal management for hemorrhage control and functional outcome perseverance in these pediatric patients with AVMs. AVM obliteration is a valid treatment goal, especially for patients with ruptured presentation, to prevent further hemorrhages later in life.

show abstract

“…The percentage of AVMs presenting with hemorrhage ranges from 30% to 82% 12. Initial presentation with hemorrhage can lead to mortality rates as high as 10–30% 2 13.…”

Section: Introductionmentioning

confidence: 99%

Increased prevalence and rupture status of feeder vessel aneurysms in posterior fossa arteriovenous malformations

Orning

Amin‐Hanjani

Hamade

et al. 2015

J NeuroIntervent Surg

View full text Add to dashboard Cite

Background Posterior fossa arteriovenous malformations (AVMs) are considered to have a higher risk of poor outcome, as are AVMs with associated aneurysms. We postulated that posterior fossa malformations may be more prone to associated feeder vessel aneurysms, and to aneurysmal source of hemorrhage. Objective To examine the prevalence and hemorrhagic risk of posterior fossa AVM-associated feeder vessel aneurysms. Methods A retrospective review of AVMs was performed with attention paid to location and presence of aneurysms. The hemorrhage status and origin of the hemorrhage was also reviewed. Results 571 AVMs were analyzed. Of 90 posterior fossa AVMs, 34 (37.8%) had aneurysms (85% feeder vessel, 9% intranidal, 15% with both

show abstract

Racial Associations with Hemorrhagic Presentation in Cerebral Arteriovenous Malformations

Cited by 26 publications

References 54 publications

Strokes Associated With Pregnancy and Puerperium

Strokes Associated With Pregnancy and Puerperium

Long-term hemorrhagic risk in pediatric patients with arteriovenous malformations

Increased prevalence and rupture status of feeder vessel aneurysms in posterior fossa arteriovenous malformations

Contact Info

Product

Resources

About