title: Clinical outcome after first and recurrent hemorrhage in patients with untreated brain arteriovenous malformation.
abstract: OBJECTIVE
  The morbidity from spontaneous hemorrhage of untreated brain arteriovenous malformations (AVM) is not well described.
  
  
  METHODS
  The 241 consecutive AVM patients (mean age 37+/-16 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, P=0.004; median NIHSS 3, P=0.322; 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 > or =2) than nonparenchymatous hemorrhages. Parenchymatous AVM hemorrhage had a significantly better outcome (median NIHSS 1) than non-AVM related hemorrhage (median NIHSS 12; P<0.0001).
  
  
  CONCLUSIONS
  Hemorrhage, either at initial presentation or during follow-up of untreated AVM patients appears to carry a lower morbidity than intracranial hemorrhage from other causes. These findings support a careful weighing of risks from interventional treatment and natural history.
authors.affiliation: Stroke Center, The Neurological Institute, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA. jchoi@neuro.columbia.edu
authors.forename: Jae H
authors.initials: JH
authors.lastname: Choi
authors.forename: Henning
authors.initials: H
authors.lastname: Mast
authors.forename: Robert R
authors.initials: RR
authors.lastname: Sciacca
authors.forename: Andreas
authors.initials: A
authors.lastname: Hartmann
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Khaw
authors.forename: Jay P
authors.initials: JP
authors.lastname: Mohr
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk