title: Underlying effect of age on outcome differences in arteriovenous malformation-associated intracerebral hemorrhage.
abstract: Brain arteriovenous malformations (AVM) are the most common cause of intracerebral hemorrhage (ICH) in young adults. Although previous studies have found that the mortality and morbidity of ICH due to AVM (AVM-ICH) is lower than in spontaneous ICH, it is unclear whether the more favorable prognosis is directly related to the presence of the vascular malformation. We included 34 patients with AVM-ICH and 187 with spontaneous intracerebral hemorrhage (sICH) due to either hypertension or cerebral amyloid angiopathy. Patient data were obtained from the prospective Intracerebral Hemorrhage Outcomes Project, which enrolls ICH patients admitted to Columbia University Medical Center. Using ICH etiology (AVM-ICH or sICH) and previously verified predictors of ICH outcome, two multivariate analyses were performed with and without age to compare the odds of death at 3 months and the functional outcome. Although mortality in AVM-ICH group was lower than the sICH group (20.6% versus 43.3%, respectively), this value was only significant when age was excluded (p=0.017) and lost its significance when we controlled for age (p=0.157). There was an analogous loss of significance with functional outcome using the modified Rankin Scale. In conclusion, our data suggests that the previously observed lower case fatality rate and more favorable functional outcomes in the AVM-ICH group compared to the sICH group may largely be the result of age.
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA; College of Physicians and Surgeons, Columbia University, New York, NY, USA. Electronic address: bet2110@cumc.columbia.edu.
authors.forename: Blake
authors.initials: B
authors.lastname: Taylor
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Appelboom
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Yang
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Eliza
authors.initials: E
authors.lastname: Bruce
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: LoPresti
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA; College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Bruce
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Christophe
authors.affiliation: Neuro-intensive care unit, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.affiliation: Cerebrovascular Laboratory, Columbia University Medical Center, 630 West 168th Street, Suite 5-454, New York, NY 10032, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA; Neuro-intensive care unit, Columbia University Medical Center, New York, NY, USA; Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: E
authors.initials: E
authors.lastname: Sander Connolly
mesh_terms: D000328:Adult; D000367:Age Factors; D016657:Cerebral Amyloid Angiopathy / Q000150:complications; D002543:Cerebral Hemorrhage / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
keywords: Age; Amyloid angiopathy; Arteriovenous malformations; Intracerebral hemorrhage; Prognosis; Prospective; Stroke