title: Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation.
abstract: OBJECTIVE
  The standard categorization of arteriovenous malformations (AVMs) involves the Spetzler-Martin grading system, which uses a simple analysis of size, location (superficial or deep), and the presence of deep or superficial drainage. Hemodynamic risk factors are also thought to play important roles in the pathogenesis of these lesions and to be associated with the intracranial hemorrhage (ICH) rate. The actual hemodynamic factors for AVMs cannot be easily measured, but angioarchitectural features can be assessed and used as surrogate parameters.
  
  
  METHODS
  The AVM angioarchitectural features for 662 patients were analyzed, and their associations with ICH as a presenting sign were studied. A cross-sectional analysis was used to qualify the strength of associations among clinical features, angioarchitectural characteristics, and ICH before treatment.
  
  
  RESULTS
  The multivariate analysis indicated that arterial stenosis and arterial ectasia were associated with lower ICH rates, whereas venous stenosis increased the rate of ICH. The presence of angiogenesis modified the effects of arterial and venous stenosis. Furthermore, the effect of venous stenosis depended on the location of the nidus. The presented data do not support a direct positive association between associated aneurysms and ICH.
  
  
  CONCLUSIONS
  Certain angiographic features seem to have prognostic potential with respect to the occurrence of ICH among patients with AVMs. A discriminatory prognostic index is proposed; its relevance must be proven in a future prospective study.
authors.affiliation: Department of Medical Statistics, Epidemiology, and Informatics, Klinikum Benjamin Franklin, Free University Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Mansmann
authors.forename: J
authors.initials: J
authors.lastname: Meisel
authors.forename: M
authors.initials: M
authors.lastname: Brock
authors.forename: G
authors.initials: G
authors.lastname: Rodesch
authors.forename: H
authors.initials: H
authors.lastname: Alvarez
authors.forename: P
authors.initials: P
authors.lastname: Lasjaunias
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000175:diagnosis / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D014655:Vascular Resistance / Q000502:physiology