on April 23, 2009
Published online before print April 23, 2009, doi: 10.1161/STROKEAHA.108.533034
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on July 28, 2008
From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK. * To whom correspondence should be addressed. E-mail: Rustam.Al-Shahi{at}ed.ac.uk.
Background and Purpose—Reported risks of hemorrhage from intracranial developmental venous anomalies (DVAs) vary, so we investigated this in a systematic review and population-based study. Methods—We systematically reviewed the literature (Ovid Medline and Embase to November 7, 2007) and selected studies of Results—Of 2068 articles detected by the literature search, 15 met our inclusion criteria and described clinical presentation, 8 of which also described the clinical course of DVAs. In the 15 studies of 714 people first presenting with a DVA, 61% were incidental findings, the mode of presentation was unclear in 23%, 6% presented with nonhemorrhagic focal neurological deficit, 6% had caused symptomatic hemorrhage, 4% were associated with epileptic seizure, and <1% were associated with infarction. In studies of the clinical course of 422 people with a DVA, the hemorrhage rate after first presentation ranged from 0% to 1.28% per year. In the population-based study of 93 adults with DVAs, 98% were incidental, 1% presented with symptomatic hemorrhage, and 1% presented with an infarct, but there were no symptomatic hemorrhages or infarcts in 492 person-years of follow-up (0% per person-year; 95% CI, 0% to 0.7%). Conclusions—Intracranial DVAs have a benign presentation and clinical course.
Accepted on October 27, 2008
The Presentation and Clinical Course of Intracranial Developmental Venous Anomalies in Adults. A Systematic Review and Prospective, Population-Based Study
Jennifer M.L. Hon BA;
20 participants with 1 DVA(s) that described their clinical presentation and/or their clinical course over a specified follow-up period. We also identified every adult first diagnosed with a DVA in Scotland from 1999 to 2003 and followed them in a prospective, population-based study.
Key words: hemorrhagic • intracranial developmental venous anomaly • stroke • vascular malformations