title: Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations.
abstract: OBJECTIVE
  To identify clinical and angiographic factors of cerebral arteriovenous malformations (AVMs) associated with hemorrhage to improve the estimation of the risks and help guide management in clinical decision making.
  
  
  METHODS
  We conducted a retrospective analysis of 100 consecutive adults who have presented during the past 3 years to our institution with cerebral AVMs. Angiographic and clinical parameters were evaluated using multivariate logistic regression analysis to analyze factors associated with hemorrhagic presentation.
  
  
  RESULTS
  The group had a mean age of 37.8 years; 53% were men, 48% presented with intracranial hemorrhage, and 40% presented with seizures. All 10 patients with cerebellar AVMs presented with hemorrhage. The following factors were independently associated with AVM hemorrhage: history of hypertension (P = 0.019; odds ratio [OR] = 5.36), nidal diameter <3 cm (P = 0.023: OR = 4.60), and deep venous drainage (P = 0.009: OR = 5.77). Dural arterial supply (P = 0.008; OR = 0.15) was independently associated with decreased risk of bleed. Location, nidal aneurysms, patient age, and smoking were not associated with increased or decreased bleeding risk.
  
  
  CONCLUSIONS
  In this study, we found small AVM size and deep venous drainage to be positively associated with AVM hemorrhage. Dural supply was associated with a decreased likelihood of hemorrhagic presentation. Hypertension was found to be the only clinical factor positively associated with hemorrhage, a finding not previously reported. Smoking, although associated with increased risk of aneurysmal subarachnoid hemorrhage, was not associated with a higher risk of AVM hemorrhage.
authors.affiliation: Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Langer
authors.forename: T M
authors.initials: TM
authors.lastname: Lasner
authors.forename: R W
authors.initials: RW
authors.lastname: Hurst
authors.forename: E S
authors.initials: ES
authors.lastname: Flamm
authors.forename: E L
authors.initials: EL
authors.lastname: Zager
authors.forename: J T
authors.initials: JT
authors.lastname: King
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology*; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging; D012307:Risk Factors; D012640:Seizures / Q000209:etiology