Hemorrhage Rates and Risk Factors in the Natural History Course of Brain Arteriovenous Malformations
- PDF / 178,277 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 97 Downloads / 198 Views
REVIEW ARTICLE
Hemorrhage Rates and Risk Factors in the Natural History Course of Brain Arteriovenous Malformations W. Caleb Rutledge & Nerissa U. Ko & Michael T. Lawton & Helen Kim
Received: 26 February 2014 / Revised: 28 May 2014 / Accepted: 30 May 2014 # Springer Science+Business Media New York 2014
Abstract Brain arteriovenous malformations (AVMs) are abnormal connections of arteries and veins, resulting in arteriovenous shunting of blood. Primary medical therapy is lacking; treatment options include surgery, radiosurgery, and embolization, often in combination. Judicious selection of AVM patients for treatment requires balancing risk of treatment complications against the risk of hemorrhage in the natural history course. This review focuses on the epidemiology, hemorrhage risk, and factors influencing risk of hemorrhage in the untreated natural course associated with sporadic brain AVM. Keywords Arteriovenous malformation . Epidemiology . Intracerebral hemorrhage . Natural history . Risk factor . Survival . Treatment
Introduction Brain arteriovenous malformations (AVMs) are comprised of a complex tangle of abnormal blood vessels called the nidus, This review is dedicated in memory of William L. Young, MD, for his unwavering dedication, enthusiastic mentorship, and probing science into understanding the pathogenesis of brain AVMs to ultimately improve the lives of people diagnosed with this disease. W. C. Rutledge : M. T. Lawton Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA N. U. Ko Department of Neurology, University of California, San Francisco, San Francisco, CA, USA H. Kim (*) Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, 1001 Potrero Avenue, Box 1363, San Francisco, CA 94110, USA e-mail: [email protected]
not clearly an artery or vein and lacking a true capillary bed. The hallmark feature is the shunting of blood directly from the arterial to venous circulations detected by cerebral angiography. There is usually high flow through the feeding arteries, nidus, and draining veins, which may result in rupture and intracranial hemorrhage, the most severe complication of an AVM. Patients commonly present with headaches, seizures, and focal neurologic deficits. Although patients with AVM rupture and intracranial hemorrhage may have better outcomes than patients with intracerebral hemorrhage from other causes, AVM rupture is still associated with significant morbidity and mortality [1]. In observational studies, the mortality rate after intracranial hemorrhage from AVM rupture ranges from 12 to 66.7 % [1, 2], and 23–40 % of survivors have significant disability [3]. Current treatment decisions are based on carefully weighing the risk of spontaneous hemorrhage in the natural history course against the risk of invasive treatment. This review focuses on the epidemiology, hemorrhage risk, and factors influencing risk of hemorrhage associated with sporadic brain AVM. We pe
Data Loading...
