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Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation

Choi, Jae H.; Mast, Henning; Sciacca, Robert R.; Hartmann, Andreas; Khaw, Alexander V.; Mohr, Jay P.; Sacco, Ralph L.; Stapf, Christian

Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation Thumbnail


Jae H. Choi

Henning Mast

Robert R. Sciacca

Andreas Hartmann

Alexander V. Khaw

Jay P. Mohr

Ralph L. Sacco

Christian Stapf


Background and Purpose: The morbidity from spontaneous hemorrhage of untreated brain arteriovenous malformations
(AVM) is not well described.
Methods: The 241 consecutive AVM patients (mean age 3716 years, 52% women) from the prospective Columbia
AVM Databank initially presenting with hemorrhage were evaluated using the Rankin Scale (RS) and the National
Institute of Health Stroke Scale (NIHSS). From the 241 AVM patients, 29 (12%) had subsequent intracranial
hemorrhage during follow-up. For further comparisons, 84 non-AVM patients with intracerebral hemorrhage from the
Northern Manhattan Study (NOMAS) served as a control group.
Results: In 241 AVM patients presenting with hemorrhage the median RS was 2 and the median NIHSS was 1 (49% RS
0 to 1, 61% NIHSS 2). The median time between hemorrhage and clinical evaluation was 11 days (mean 219 days).
Recurrent AVM hemorrhage during follow-up resulted in no significant increase in morbidity (median RS 2, P0.004;
median NIHSS 3, P0.322; time between hemorrhage and study evaluation: median 55 days, mean 657 days). Among
AVM-hemorrhage subtypes, parenchymatous AVM hemorrhage was associated with higher stroke morbidity (odds
ratio, 2.9; 95% CI, 1.5 to 5.8 for NIHSS 2) than nonparenchymatous hemorrhages. Parenchymatous AVM hemorrhage
had a significantly better outcome (median NIHSS 1) than non-AVM related hemorrhage (median NIHSS 12;
Conclusions: Hemorrhage, either at initial presentation or during follow-up of untreated AVM patients appears to carry

Journal Article Type Article
Acceptance Date Mar 1, 2006
Online Publication Date Apr 13, 2006
Publication Date Apr 13, 2006
Deposit Date May 15, 2007
Publicly Available Date Aug 22, 2008
Journal Stroke
Print ISSN 0039-2499
Electronic ISSN 1524-4628
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 37
Issue 5
Pages 1243-1247
Keywords cerebral arteriovenous; malformations; intracerebral hemorrhage; intracranial hemorrhage outcome; subarachnoid hemorrhage
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