gms | German Medical Science

Objective: Selecting between ruptured and unruptured cerebral cavernomas (CCM) may sometimes be challenging. While inflammatory burden is highly debated in the disease pathogenesis of cerebral cavernoma, we investigated laboratory systemic inflammatory markers to stratify between ruptured and unruptured CCM.

Methods: Eighty-seven cerebral cavernoma patients who underwent surgical resection were included in this retrospective single-center series. Indications for resection included hemorrhage, and symptomatic epilepsy without hemorrhage. Patients underwent MR imaging before and aftzer surgery. CCMs were analyzed histopathologically. Clinical, radiological, and histological data were analyzed.

Results: Receiver operating characteristic curve revealed a strong diagnostic performance of white blood cell count (WBC) at admission in the prediction of bleeding from cavernoma (Area under curve (AUC): 0.74; 95% CI: 0.63–0.84, cut-off: ≥6.595/<6.595, sensitivity: 66%, specificity: 70%, Youden´s index: 0.36). Univariable analysis found that nicotine abuse, blood-borne diseases, connective tissue diseases, and dexamethasone intake were homogeneously distributed among the low- (<6.595) and high (≥6.595) WBC groups. Multivariable analysis considering the demographic confounders (sex & age) and WBC confirmed WBC ≥6.595 (Adjusted Odds ratio: 4.5, 95% CI: 1.8-11.2, p = 0.001) as an independent predictor of bleeding from cerebral cavernoma.

Conclusion: White blood cell count ≥ 6.595 was significantly associated with ruptured CCM, and seems to be a quick-to-use biomarker in controversial cases. Further investigations are needed to analyze the role of inflammation in cerebral cavernoma and the disease specific clinical endpoints (e.g., bleeding, symptomatic seizure).

Figure 1 [Fig. 1], Table 1 [Tab. 1]