Seizures in Cerebral Arteriovenous Malformations: Type, Clinical Course, and Medical Management

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Background and Purpose-We sought to assess the relative risk of hemorrhagic presentation of brain arteriovenous malformations (AVMs) located in the arterial borderzone territories. Methods-The 464 consecutive, prospectively enrolled patients from the New York AVM Databank were analyzed. AVM borderzone location was coded positive when the malformation was supplied by branches of at least 2 of the major circle of Willis arteries (anterior, middle, and/or posterior cerebral arteries). AVMs fed by branches of only 1 major pial or any other single artery served as a comparison group. Clinical presentation (diagnostic event) was categorized as (1) intracranial hemorrhage, proven by brain imaging, or (2) seizure, focal neurological deficit, headache, or other event with no signs of AVM hemorrhage on brain imaging. Results-In 48% (nϭ222) of the patients, AVMs were located in the arterial borderzone territories; in 52% (nϭ242) a non-borderzone location was found. Hemorrhage was the presenting symptom in 44% (nϭ205); 28% (nϭ132) presented with seizures, 11% (nϭ52) with headaches, 7% (nϭ34) with a neurological deficit, and 9% (nϭ41) with other or no AVM-related symptoms. The frequency of incident AVM hemorrhage was significantly lower in borderzone AVMs (27%, nϭ61) than in non-borderzone malformations (60%, nϭ144; PϽ0.001). This difference remained significant in a multivariate model controlling for age, sex, AVM size, deep venous drainage, and presence of aneurysms (odds ratio, 0.4; 95% CI, 0.25 to 0.66). Conclusions-Our findings suggest that borderzone location is an independent determinant for a lower risk of AVM hemorrhage at initial presentation. (Stroke. 2000;31:2365-2368.)

Section: Discussionsupporting

confidence: 88%

Incident Hemorrhage Risk of Brain Arteriovenous Malformations Located in the Arterial Borderzones

Stapf

Mohr

Sciacca

et al. 2000

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“…For other modes of AVM presentation, the occurrence of symptomatic seizures also showed a significant association with age. The additional association of age with AVM size and borderzone location, both known predictors for AVM-related seizures, 15,22,23 further supports the plausibility of these findings.…”

Section: Discussionmentioning

confidence: 56%

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

Stapf

Khaw

Sciacca

et al. 2003

Self Cite

140

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.

“…2,26 Spontaneous intracranial hemorrhage from a cerebral AVM should result from a finite set of physiological and anatomic abnormalities in a given patient. As outlined in Table 7, several studies have addressed the issue of risk factor identification.…”

Section: Discussionmentioning

confidence: 99%

Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations

Duong

Young

Vang

et al. 1998

209

Purpose-The purpose of this study was to define the influence of feeding mean arterial pressure (FMAP) in conjunction with other morphological or clinical risk factors in determining the probability of hemorrhagic presentation in patients with cerebral arteriovenous malformations (AVMs). Methods-Clinical and angiographic data from 340 patients with cerebral AVMs from a prospective database were reviewed. Patients were identified in whom FMAP was measured during superselective angiography. Additional variables analyzed included AVM size, location, nidus border, presence of aneurysms, and arterial supply and venous drainage patterns. The presence of arterial aneurysms was also correlated with site of bleeding on imaging studies. Results-By univariate analysis, exclusively deep venous drainage, periventricular venous drainage, posterior fossa location, and FMAP predicted hemorrhagic presentation. When we used stepwise multiple logistic regression analysis in the cohort that had FMAP measurements (nϭ129), only exclusively deep venous drainage (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.4 to 9.8) and FMAP (OR, 1.4 per 10 mm Hg increase; 95% CI, 1.1 to 1.8) were independent predictors (PϽ0.01) of hemorrhagic presentation; size, location, and the presence of aneurysms were not independent predictors. There was also no association (Pϭ0.23) between the presence of arterial aneurysms and subarachnoid hemorrhage. Conclusions-High arterial input pressure (FMAP) and venous outflow restriction (exclusively deep venous drainage)were the most powerful risk predictors for hemorrhagic AVM presentation. Our findings suggest that high intranidal pressure is more important than factors such as size, location, and the presence of arterial aneurysms in the pathophysiology of AVM hemorrhage.