Artikel
Different patterns in AVM haemorrhage and their impact on outcome. Implications for risk stratification
Unterschiedliche Blutungsmuster bei AVM-Blutungen und deren Auswirkung auf das Outcome – die Signifikanz zur Risikoeinschätzung
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Mai 2019 |
---|
Gliederung
Text
Objective: Cerebral vasospasm (CVS) after a ruptured arteriovenous malformation (AVM) is rarely reported. The aim of the present study is to evaluate different bleeding patterns in AVM hemorrhage and the incidence of CVS for risk and treatment stratification.
Methods: We evaluated 160 patients with ruptured AVMs who were admitted to our neurosurgical department from 2002 to 2017. Arterial and venous AVM associated aneurysms and the incidence of vasospasm after AVM rupture were reviewed. We compared different bleeding patterns, such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) or both (ICH+SAH) and evaluated predictive variables for outcome in last follow up.
Results: ICH was found in 78 (48.8%) patients, only SAH in 33 (20.6%) patients and both in 49 (30.6%) patients. The mean parenchymal blood volume was 29.6cm3. 62 (38.8%) patients had AVM associated aneurysms, mostly located prenidal (75.8%). AVMs with ruptured aneurysms often resulted in ICH with SAH component (p<0.001). CVS occured in five patients (3.1%). All ruptured AVMs with CVS were located infratentorial (p<0.002). Cerebral infarction (CI) was significantly associated with the incidence of CVS (p<0.04). Bleeding pattern did not affect the incidence of CVS or CI (p>0.05). Initial admission state (p<0.01), ICH with SAH component (p<0.04), CVS (p<0.01) and CI (p<0.001) were statistical significant predictors for worse outcome.
Conclusion: Bleeding pattern in AVM hemorrhage depends on angioarchitectural and hemodynamic features and ruptured flow associated prenidal aneurysms may harbor a higher risk for CVS. Follow up with angiographic imaging should be considered in patients with delayed neurologic deterioration to rule out CVS after AVM hemorrhage.