title: Natural history and imaging prevalence of cavernous malformations in children and young adults.
abstract: OBJECTIVE
  This study was undertaken to define the age-related prevalence of cavernous malformations (CMs) in children and young adults undergoing intracranial imaging. In addition, the authors aim to clarify the natural history of CMs in young people, especially in those with incidentally discovered lesions.
  
  
  METHODS
  To identify those patients with CMs, the authors retrospectively reviewed the electronic medical records of 14,936 consecutive patients 25 years of age or younger who had undergone brain MR imaging. In patients with a CM, clinical and imaging data were collected. Patients with untreated cavernomas who had more than 6 months of clinical and MR imaging follow-up were included in a natural history analysis. The natural history analysis included 110 CMs in 56 patients with a 3.5-year mean clinical follow-up interval (199 patient-years and 361 cavernoma-years).
  
  
  RESULTS
  In 92 patients (0.6%), 164 CMs were identified. The imaging prevalence of cavernomas increased with advancing age (p = 0.002). Multiple CMs occurred in 28 patients (30%), and 8 patients (9%) had a family history of multiple CMs. Fifty patients (54%) presented with symptoms related to the cavernoma, of whom 30 presented with hemorrhage (33%). Of the 164 cavernomas identified, 103 (63%) were considered incidental, asymptomatic lesions. Larger size was associated with acute symptomatic presentation (p = 0.0001). During the follow-up interval, 6 patients with 8 cavernomas developed 11 symptomatic hemorrhages after initial identification. Five of the patients who had a hemorrhage during the follow-up interval had initially presented with hemorrhage, while only 1 had presented incidentally. The hemorrhage rate for all patients in the natural history group was 1.6% per patient-year and 0.9% per cavernoma-year. The hemorrhage rate was 8.0% per patient-year in the symptomatic group versus 0.2% in the incidental group. Symptomatic hemorrhage after long-term follow-up was associated with initial acute presentation (p = 0.02).
  
  
  CONCLUSIONS
  The imaging prevalence of CM increases with advancing age during childhood. Patients presenting without hemorrhage have a significantly lower risk of bleeding compared with those who present with acute neurological symptoms. Comparing this series of children to prior analyses of CM natural history in adults, the authors' data do not suggest a higher bleeding risk in younger patients.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-5338, USA.
authors.forename: Wajd N
authors.initials: WN
authors.lastname: Al-Holou
authors.forename: Thomas M
authors.initials: TM
authors.lastname: O'Lynnger
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.forename: Karin M
authors.initials: KM
authors.lastname: Muraszko
authors.forename: Hugh J L
authors.initials: HJ
authors.lastname: Garton
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D055815:Young Adult