title: Solitary Sporadic Cerebral Cavernous Malformations: Risk Factors of First or Recurrent Symptomatic Hemorrhage and Associated Functional Impairment.
abstract: OBJECTIVE
  To quantify the risk of a first or recurrent hemorrhage and the associated functional impairment in patients with sporadic solitary cerebral cavernous malformations (CCMs) and to investigate the potential risk factors.
  
  
  METHODS
  We undertook an observational study (n = 199) of consecutive patients with the diagnosis of a single, sporadic CCM using clinical and magnetic resonance imaging follow-up to identify prospective hemorrhage events and associated functional impairment. We calculated the annual hemorrhage risk rates, calculated cumulative risks, and performed uni- and multivariate analysis to assess outcome predictors.
  
  
  RESULTS
  There were 199 adults identified, and 712.5 person years of follow-up were analyzed. Overall annual rates of hemorrhage were 6.03%, 11.95%, and 1.03% in the complete cohort, in those presenting with previous hemorrhage, and in those without, respectively. The 5-year risk of hemorrhage was higher in those presenting with previous hemorrhage than those without (40.9%; 95% confidence interval [CI], 31.78-50.73 vs. 8.6%; 95% CI, 3.97-16.95; P < 0.0001) and in those with a brainstem CCM compared with nonbrainstem CCM (51.6%; 95% CI, 37.61-65.46 vs. 17.1%; 95% CI, 4.55-32.04; P < 0.0001). In the multivariate analysis, previous hemorrhage (odds ratio, 7.18; 95% CI, 1.8-28.11; P = 0.005), age less than 45 years (odds ratio, 2.61; 95% CI, 1.03-6.61; P = 0.042), and brainstem location (odds ratio, 7.44; 95% CI, 2.09-26.50; P = 0.002) increased the risk of hemorrhage. Of the patients, 30% showed a moderate or severe disability associated with a CCM hemorrhage (5-year risk of severe hemorrhage, 8.9%; 95% CI, 5.50-13.99).
  
  
  CONCLUSIONS
  This study provides an estimate of symptomatic hemorrhage risk and the associated disability in patients with sporadic solitary CCM and an investigation of risk factors.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. Electronic address: philipp.dammann@uk-essen.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Dammann
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Jabbarli
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Paula
authors.initials: P
authors.lastname: Wittek
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Marvin Darkwah
authors.initials: MD
authors.lastname: Oppong
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kneist
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Wrede
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Müller
authors.affiliation: Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Forsting
authors.affiliation: Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
mesh_terms: D000328:Adult; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000453:epidemiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors
keywords: Cerebral cavernous malformation; Functional impairment; Intracerebral hemorrhage; Natural history