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(Stroke. 2004;35:660.)
© 2004 American Heart Association, Inc.

Original Contributions

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 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.).

Correspondence to Alexander V. Khaw, MD, Neurological Institute, Columbia University, Doris & Stanley Tananbaum Stroke Center, NI 6-14, 710 West 168th Street, New York, NY 10032. 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

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