Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae.

OBJECTIVE

Intracranial dural arteriovenous fistulae (DAVFs) can present as disabling intracranial hemorrhage. The aim of this study was to investigate the independent effects of specific demographic and clinical variables on hemorrhagic presentation in patients with DAVFs.

METHODS

All patients with DAVFs evaluated at the University of California at San Francisco from July 1988 through June 2004 were identified. Clinical and radiographic characteristics were recorded using a detailed abstraction form.

RESULTS

A total of 402 patients with DAVFs were identified, 73 (18%) of whom presented with intracranial hemorrhage. Men were twice as likely to present with hemorrhage (men 70% versus women 30%, P < 0.001). Cortical venous drainage (85 versus 22%; P < 0.001), retrograde venous drainage (59 versus 36%; P < 0.001), and sinus occlusion (33 versus 18%; P = 0.004) were also more common in patients with DAVF with hemorrhagic presentation. In multivariate logistic regression analysis, cortical venous drainage (odds ratio [OR], 10.5; P < 0.001), focal neurological deficits (OR, 4.7; P < 0.001), DAVFs in the posterior fossa (OR, 4.0; P = 0.005), male sex (OR, 3.4, P = 0.001), and age older than 50 years were found to be independently associated with hemorrhagic presentation.

CONCLUSION

Although DAVFs are less frequent in men than in women, they are more likely to present with hemorrhage. In addition to cortical venous drainage, a well-known risk factor for intracranial hemorrhage, posterior fossa location, older age at presentation, and focal neurological deficits were independently associated with hemorrhagic presentation in patients with DAVFs.