title: The presentation and clinical course of intracranial developmental venous anomalies in adults: a systematic review and prospective, population-based study.
abstract: OBJECTIVE
  Reported risks of hemorrhage from intracranial developmental venous anomalies (DVAs) vary, so we investigated this in a systematic review and population-based study.
  
  
  METHODS
  We systematically reviewed the literature (Ovid Medline and Embase to November 7, 2007) and selected studies of >or=20 participants with >or=1 DVA(s) that described their clinical presentation and/or their clinical course over a specified follow-up period. We also identified every adult first diagnosed with a DVA in Scotland from 1999 to 2003 and followed them in a prospective, population-based study.
  
  
  RESULTS
  Of 2068 articles detected by the literature search, 15 met our inclusion criteria and described clinical presentation, 8 of which also described the clinical course of DVAs. In the 15 studies of 714 people first presenting with a DVA, 61% were incidental findings, the mode of presentation was unclear in 23%, 6% presented with nonhemorrhagic focal neurological deficit, 6% had caused symptomatic hemorrhage, 4% were associated with epileptic seizure, and <1% were associated with infarction. In studies of the clinical course of 422 people with a DVA, the hemorrhage rate after first presentation ranged from 0% to 1.28% per year. In the population-based study of 93 adults with DVAs, 98% were incidental, 1% presented with symptomatic hemorrhage, and 1% presented with an infarct, but there were no symptomatic hemorrhages or infarcts in 492 person-years of follow-up (0% per person-year; 95% CI, 0% to 0.7%).
  
  
  CONCLUSIONS
  Intracranial DVAs have a benign presentation and clinical course.
authors.affiliation: Division of Clinical Neurosciences, Western General Hospital, University of Edinburgh, Edinburgh, UK.
authors.forename: Jennifer M L
authors.initials: JM
authors.lastname: Hon
authors.forename: Jo J
authors.initials: JJ
authors.lastname: Bhattacharya
authors.forename: Carl E
authors.initials: CE
authors.lastname: Counsell
authors.forename: Vakis
authors.initials: V
authors.lastname: Papanastassiou
authors.forename: Vaughn
authors.initials: V
authors.lastname: Ritchie
authors.forename: Richard C
authors.initials: RC
authors.lastname: Roberts
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Sellar
authors.forename: Charles P
authors.initials: CP
authors.lastname: Warlow
authors.forename: Rustam
authors.initials: R
authors.lastname: Al-Shahi Salman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000628:therapy; D002544:Cerebral Infarction / Q000209:etiology / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000453:epidemiology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011153:Population; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D012640:Seizures / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult