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(Stroke. 1998;29:2001-2003.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Morbidity of Intracranial Hemorrhage in Patients With Cerebral Arteriovenous Malformation

Michael Morgan, MD, FRACS; Lali Sekhon, PhD, FRACS; Zurin Rahman, MD, MS; Gordon Dandie, MBBS

Department of Surgery, University of Sydney, and Department of Neurosurgery, Royal North Shore Hospital, St Leonards, Australia

To the Editor:

The Columbia-Presbyterian Medical Center Arteriovenous Malformation Study Project has made, and continues to make, a significant contribution to our understanding of arteriovenous malformations of the brain. In the recent contribution of Hartmann et al,¹ a number of interesting observations were made with regard to hemorrhage. The first is the high incidence among those that bleed of subarachnoid and intraventricular hemorrhage. Only 54% of initial hemorrhages and 49% of follow-up hemorrhage were intraparenchymal. This is at considerable variance with our experience at the Northern and Western Medical School, The University of Sydney, where we have followed all arteriovenous malformations (AVMs) seen since 1991, and of 114 patients presenting with hemorrhage, 82% have a significant intraparenchymal component.

One is left with the feeling from this article that hemorrhage from AVMs is relatively benign. However, it must be borne in mind that this is a specially selected subset of patients referred to a tertiary service. The authors of this article acknowledge that they were not able to ascertain the number of patients that were ineligible for referral because of death. One also wonders whether patients with a poor quality of life as a result of hemorrhage were also excluded from referral. A much more significant study in this regard is the excellent report of 31 patients followed up at the Mayo Clinic until initial hemorrhage, with 29% mortality and 16% permanent neurological deficit.² Unfortunately, there were only 4 such patients reported by the Columbia-Presbyterian Medical Center Arteriovenous Malformation Study Project.¹

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Andreas Hartmann, MD; Henning Mast, MD

Stroke Unit, Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY, Neurologische Klinik, Universitaetsklinikum Benjamin Franklin, Berlin, Germany

William L. Young, MD

Department of Anesthesiology

J.P. Mohr, MD

Stroke Unit, Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY