Published Online
on October 23, 2003

A more recent version of this article appeared on November 1, 2003

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Submitted on May 15, 2003
Accepted on June 13, 2003

Effect of Age on Clinical and Morphological Characteristics in Patients With Brain Arteriovenous Malformation

C. Stapf MD^*; A. V. Khaw MD; R. R. Sciacca EngScD; C. Hofmeister PhD; H. C. Schumacher MD; J. Pile-Spellman MD; H. Mast MD; J. P. Mohr MD; and A. Hartmann MD

From the Stroke Center, Neurological Institute (C.S., A.V.K., C.H., H.M., J.P.M.), Interventional Neuroradiology (H.C.S., J.P.-S.), and Medicine (R.R.S.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Neurology, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Germany (C.S., A.H.); and Department of Neurology, Hôpital Lariboisière, Paris, France (C.S.).

^* To whom correspondence should be addressed. E-mail: cstapf{at}neuro.columbia.edu.

Background and Purpose--The goal of this work was to determine the effect of age at initial presentation on clinical and morphological characteristics in patients with brain arteriovenous malformation (AVM).

Methods--The 542 consecutive patients from the prospective Columbia AVM database (mean±SD age, 34±15 years) were analyzed. Univariate statistical models were used to test the effect of age at initial presentation on clinical (AVM hemorrhage, seizures, headaches, neurological deficit, other/asymptomatic) and morphological (AVM size, venous drainage pattern, AVM brain location, concurrent arterial aneurysms) characteristics.

Results--Hemorrhage was the presenting symptom in 46% (n=247); 29% (n=155) presented with seizures, 13% (n=71) with headaches, 7% (n=36) with a neurological deficit, and 6% (n=33) without AVM-related symptoms. Increasing age correlated positively with intracranial hemorrhage (P=0.001), focal neurological deficits (P=0.007), infratentorial AVMs (P<0.001), and concurrent arterial aneurysms (P<0.001); an inverse correlation was found with seizures (P<0.001), AVM size (P=0.001), and lobar (P<0.001), deep (P=0.008), and borderzone (P=0.014) location. No age differences were found for sex, headache, asymptomatic presentation, and venous drainage pattern.

Conclusions--Our data suggest a significant interaction of patient age and clinical and morphological AVM features and argue against uniform AVM characteristics across different age classes at initial presentation. In particular, AVM patients diagnosed at a higher age show a higher fraction of AVM hemorrhage and are more likely to harbor additional risk factors such as concurrent arterial aneurysms and small AVM diameter. Longitudinal population-based AVM data are necessary to confirm these findings.

Key words: aneurysm • cerebral arteriovenous malformations • intracranial hemorrhages • seizures • stroke

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