title: Management of ruptured brain arteriovenous malformations.
abstract: Intracranial arteriovenous malformations (AVMs) are a common cause of stroke in younger patients, and often present as intracerebral hemorrhages (ICH), associated with 10 % to 30 % mortality. Patients who present with a hemorrhage from an AVM should be initially stabilized according to acute management guidelines for ICH. The characteristics of a lesion including its size, location in eloquent tissue, and high-risk features will influence risk of rupture, prognosis, as well as help guide management decisions. Given that rupture is associated with an increased risk of 6 % re-rupture in the year following the initial hemorrhage, versus 1 % to 3 % predicted annual risk in non-ruptured lesions only, definitive treatment is encouraged after ICH stabilization. A rest period of 2 to 6 weeks after hemorrhage is recommended before definitive treatment to avoid disrupting friable parenchyma and the hematoma. Treatment may consist of endovascular embolization, surgical resection, radiosurgery, or a combination of these three interventions based on the lesion.
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, NY 10032, USA. bez2103@columbia.edu
authors.forename: Brad E
authors.initials: BE
authors.lastname: Zacharia
authors.forename: Kerry A
authors.initials: KA
authors.lastname: Vaughan
authors.forename: Adam
authors.initials: A
authors.lastname: Jacoby
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Hickman
authors.forename: Daniel
authors.initials: D
authors.lastname: Bodmer
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001164:Arteriovenous Fistula / Q000150:complications / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000628:therapy*; D003029:Coagulants / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D012422:Rupture, Spontaneous
chemical_list: D000959:Antihypertensive Agents; D003029:Coagulants