Morbidity of intracranial hemorrhage in patients with cerebral arteriovenous malformation
Morbidity of intracranial hemorrhage in patients with cerebral arteriovenous malformation
复制标题
DOI：
10.1161/01.str.29.5.931
复制
发表时间：
1998-05-01
期刊：
影响因子：
8.3
通讯作者：
Young, WL
中科院分区：
文献类型：
--
作者：
Hartmann, A;Mast, H;Young, WL
背景和目的：目前关于侵袭性动静脉畸形（AVM）治疗的决定是基于AVM出血的自然病程风险评估和一般脑出血的发病率假设。然而，AVM出血的发病率很少报道。我们试图评估脑动静脉畸形患者颅内出血的发病率。方法：从前瞻性AVM数据库中，对119例患者进行分析：115例以出血为诊断事件，其中27例在随访期间再次出血；另有4例患者有其他诊断症状，但在随访期间出血。通过CT/MR脑显像确定AVM出血的类型（脑实质、蛛网膜下腔、脑室内）和部位。采用Barthel指数、Rankin量表和美国国立卫生研究院卒中量表评估残疾和神经功能损害，平均随访时间为16.2个月。结果：115例出血中，蛛网膜下腔出血34例（30%），实质出血27例（23%），脑室出血18例（16%），合并出血36例（31%）。54例患者（47%，95%可信区间[CI]， 38%至56%）的意外出血没有导致神经功能缺损，另外43例患者（37%,95% CI， 28%至46%）能够独立进行日常活动（Rankin 1）。15例（13%;95% CI, 7% ~ 19%）为中度残疾（Rankin 2或3），3例（3%;95% CI, 0% ~ 6%）为重度残疾（Rankin大于等于4）。实质出血最可能导致神经功能缺损（52%）。随访期间出血的类型和发病率与事件相似。27例同时发生出血和随访出血的患者中，20例（74%）为正常或独立出血（Rankin值为0或1），随访期间发生出血的患者无一例在观察期间死亡。结论：脑动静脉畸形出血的发病率似乎低于目前的假设。这一发现鼓励人们重新评估侵入性动静脉畸形治疗的风险和益处。
Background and Purpose-Decisions on invasive arteriovenous malformation (AVM) treatment are currently based on natural-course risk estimates of AVM bleeding and assumptions on morbidity from cerebral hemorrhage in general. However, morbidity of AVM hemorrhage has rarely been reported. We sought to assess the morbidity of intracranial hemorrhage in patients with cerebral AVMs.Methods-From a prospective AVM database, 119 patients were analyzed: 115 had a hemorrhage as the diagnostic event, and 27 of them suffered a second hemorrhage during follow-up; an additional 4 patients had other diagnostic symptoms but bled during follow-up. The type (parenchymal, subarachnoid, intraventricular) and location of AVM hemorrhage were determined by CT/MR brain imaging. Disability and neurological impairment were assessed with the Barthel Index, the Rankin Scale, and the National Institutes of Health Stroke Scale, with a mean follow-up time of 16.2 months.Results-Of the 115 incident hemorrhages, 34 (30%) were subarachnoid, 27 (23%) parenchymal, 18 (16%) intraventricular, and 36 (31%) in combined locations. In 54 patients (47%; 95% confidence interval [CI], 38% to 56%) the incident hemorrhage resulted in no neurological deficit, and an additional 43 patients (37%; 95% CI, 28% to 46%) were independent in their daily activities (Rankin 1). Fifteen patients (13%; 95% CI, 7% to 19%) were moderately disabled (Rankin 2 or 3), and 3 (3%; 95% CI, 0% to 6%) were severely disabled (Rankin greater than or equal to 4). Parenchymal hemorrhages were most likely to result in a neurological deficit (52%). Type and morbidity of hemorrhage during follow-up were similar to incident events. Twenty (74%) of 27 patients with both incident and follow-up hemorrhages were normal or independent (Rankin 0 or 1), None of the patients with a hemorrhage during follow-up died during the observation period.Conclusions-Hemorrhage from cerebral AVMs appears to have a lower morbidity than currently assumed. This finding encourages a reevaluation of the risks and benefits of invasive AVM treatment.