Published Online
on January 29, 2004

A more recent version of this article appeared on March 1, 2004

This Article Full Text (PDF) All Versions of this Article: 35/3/660    most recent 01.STR.0000117093.59726.F9v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khaw, A. V. Articles by Stapf, C. Search for Related Content PubMed PubMed Citation Articles by Khaw, A. V. Articles by Stapf, C. Related Collections Acute Cerebral Hemorrhage Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage

Submitted on October 29, 2003
Accepted on November 19, 2003

Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation

A. V. Khaw MD^*; J. P. Mohr MS, MD; R. R. Sciacca EngSciD; H. C. Schumacher MD; A. Hartmann MD; J. Pile-Spellman MD; H. Mast MD; and C. Stapf MD

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

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

Background and Purpose--The goal of this study was to analyze the association of hemorrhagic presentation with infratentorial brain arteriovenous malformations (AVMs).

Methods--The 623 consecutive, prospectively enrolled patients from the Columbia AVM Databank were analyzed in a cross-sectional study. Clinical presentation (diagnostic event) was categorized as intracranial hemorrhage or nonhemorrhagic presentation. From brain imaging and cerebral angiography, AVM location was classified as either infratentorial or supratentorial. Univariate and multivariate statistical models were applied to test the effect of age, sex, AVM size and location, venous drainage pattern, and associated (ie, feeding artery or intranidal) arterial aneurysms on the likelihood of hemorrhage at initial AVM presentation.

Results--Of the 623 patients, 72 (12%) had an infratentorial and 551 (88%) had a supratentorial AVM. Intracranial hemorrhage was the presenting symptom in 283 patients (45%), and infratentorial AVM location was significantly more frequent (18%) among patients who bled initially (6%; odds ratio [OR], 3.60; 95% confidence interval [CI], 2.09 to 6.20). This difference remained significant (OR, 1.99; 95% CI, 1.07 to 3.69) in the multivariate logistic regression model controlling for age, sex, AVM size, deep venous drainage, and associated arterial aneurysms. In the same model, the effect of other established determinants for AVM hemorrhage--ie, AVM size (in 1-mm increments; OR, 0.95; 95% CI, 0.94 to 0.96), deep venous drainage (OR, 3.09; 95% CI, 1.87 to 5.12), and associated aneurysms (OR, 2.78; 95% CI, 1.76 to 4.40)--remained significant.

Conclusions--Our findings suggest that infratentorial AVM location is independently associated with hemorrhagic AVM presentation.

Key words: cerebral arteriovenous malformations • hemorrhage

This article has been cited by other articles:

				L da Costa, L Thines, A R Dehdashti, M C Wallace, R A Willinsky, M Tymianski, M L Schwartz, and K G t. Brugge Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience J. Neurol. Neurosurg. Psychiatry, April 1, 2009; 80(4): 376 - 379. [Abstract] [Full Text] [PDF]

				L. da Costa, M. C. Wallace, K. G. ter Brugge, C. O'Kelly, R. A. Willinsky, and M. Tymianski The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations Stroke, January 1, 2009; 40(1): 100 - 105. [Abstract] [Full Text] [PDF]

				J. F. Dashe, C. Stapf, and J .P. Mohr Predictors of hemorrhage in patients with untreated brain arteriovenous malformation Neurology, February 13, 2007; 68(7): 535 - 535. [Full Text] [PDF]