title: Admission risk factors for cerebral vasospasm in ruptured brain arteriovenous malformations: an observational study.
abstract: BACKGROUND
  Cerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs). Here, our purpose was to identify risk factors for cerebral vasospasm after BAVM rupture in patients requiring intensive care unit (ICU) admission.
  
  
  METHODS
  Patients admitted to our ICU from January 2003 to May 2010 for BAVM rupture were included in this observational study. Clinical, laboratory and radiological features from admission to ICU discharge were recorded. The primary endpoint was cerebral vasospasm by transcranial Doppler (TCD-VS) or cerebral infarction (CI) associated with vasospasm. Secondary endpoints included the Glasgow Outcome Scale (GOS) at ICU discharge.
  
  
  RESULTS
  Of 2,734 patients admitted to our ICU during the study period, 72 (2.6%) with ruptured BAVM were included. TCD-VS occurred in 12 (17%) and CI in 6 (8%) patients. All patients with CI had a previous diagnosis of TCD-VS. A Glasgow Coma Scale score <8 was a risk factor for both TCD-VS (relative risk (RR), 4.7; 95% confidence interval (95% CI), 1.6 to 26) and CI (RR, 7.8; 95% CI, 0.1 to 63). Independent risk factors for TCD-VS by multivariate analysis were lower Glasgow Coma Scale score (odds ratio (OR) per unit decrease, 1.38; 95% CI, 1.13 to 1.80), female gender (OR, 4.86; 95% CI, 1.09 to 25.85), and younger age (OR per decade decrease, 1.39; 95% CI, 1.05 to 1.82). The risk of a poor outcome (GOS <4) at ICU discharge was non-significantly increased in the patients with TCD-VS (RR, 4.9; 95% CI, 0.7 to 35; P = 0.09). All six patients with CI had poor outcomes.
  
  
  CONCLUSIONS
  This is the first cohort study describing the incidence and risk factors for cerebral vasospasm after BAVM rupture. Larger studies are needed to investigate the significance of TCD-vasospasm and CI in these patients.
authors.affiliation: Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie- Paris 6, 47-83 boulevard de l'hôpital, Paris 75651, France.
authors.forename: Vibol
authors.initials: V
authors.lastname: Chhor
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Manach
authors.forename: Fréderic
authors.initials: F
authors.lastname: Clarençon
authors.forename: Aurélien
authors.initials: A
authors.lastname: Nouet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Daban
authors.forename: Lamine
authors.initials: L
authors.lastname: Abdennour
authors.forename: Louis
authors.initials: L
authors.lastname: Puybasset
authors.forename: Thomas
authors.initials: T
authors.lastname: Lescot
mesh_terms: D000328:Adult; D001921:Brain; D016001:Confidence Intervals; D005260:Female; D005602:France / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D012307:Risk Factors; D012421:Rupture / Q000503:physiopathology*; D014463:Ultrasonography; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*