title: Relevance of bleeding pattern on clinical appearance and outcome in patients with hemorrhagic brain arteriovenous malformations.
abstract: Although several descriptions of the angioarchitectural features of brain arteriovenous malformations (AVMs) associated with higher hemorrhagic risk have been reported, the prognostic value of the different bleeding patterns still needs to be elucidated. This study evaluated the influence on clinical appearance and outcome of the parenchymal and non-parenchymal (subarachnoid hemorrhage-SAH-and intraventricular hemorrhage-IVH) bleedings associated with ruptured AVMs. Clinical records and neuroradiological examinations of 30 patients with hemorrhagic AVMs were reviewed in order to identify their angioarchitectural features and the associated bleeding pattern. These data along with demographic characteristics and treatment modality were dichotomized and their relationship with clinical status at admission and follow-up was tested. IVH as well as parenchymal hematomas larger than 20 cm(3) appeared associated with a severe clinical status at admission, whereas SAH involving basal cisterns was significantly associated with unfavorable outcome. Age, sex and angioarchitectural features did not show significant association with the severity of the prognosis. However, none of these bleeding patterns appeared as an independent risk factor of poor outcome at multivariate analysis. In conclusion, our data emphasized the possibility that non-parenchymal bleeding may worsen the outcome of patients with hemorrhagic AVMs.
authors.affiliation: Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy. cropcircle.2000@virgilio.it
authors.forename: Carmelo Lucio
authors.initials: CL
authors.lastname: Sturiale
authors.forename: Alfredo
authors.initials: A
authors.lastname: Puca
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Calandrelli
authors.forename: Sonia
authors.initials: S
authors.lastname: D'Arrigo
authors.forename: Alessio
authors.initials: A
authors.lastname: Albanese
authors.forename: Enrico
authors.initials: E
authors.lastname: Marchese
authors.forename: Andrea
authors.initials: A
authors.lastname: Alexandre
authors.forename: Cesare
authors.initials: C
authors.lastname: Colosimo
authors.forename: Giulio
authors.initials: G
authors.lastname: Maira
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002552:Cerebral Ventricles / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000097:blood* / Q000150:complications / Q000628:therapy*; D020300:Intracranial Hemorrhages / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D011379:Prognosis; D012959:Socioeconomic Factors; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome