Al-Shahi Salman Rustam, Berg Michel J, Morrison Leslie, Awad Issam A
Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Stroke. 2008 Dec;39(12):3222-30. doi: 10.1161/STROKEAHA.108.515544. Epub 2008 Oct 30.
Cavernous malformations of the brain (CMs) cause intracranial hemorrhage, but its reported frequency varies, partly attributable to study design. To improve the validity of future research, we aimed to develop a robust definition of CM hemorrhage.
We systematically reviewed the published literature (Ovid Medline and Embase to June 1, 2007) for definitions of CM hemorrhage used in studies of the untreated clinical course of >or=20 participants with CM(s), to inform the development of a consensus statement on the clinical and imaging features of CM hemorrhage at a scientific workshop of the Angioma Alliance.
A systematic review of 1426 publications about CMs in humans, revealed 15 studies meeting our inclusion criteria. Although 14 (93%) studies provided a definition of CM hemorrhage, data were less complete on the confirmatory type(s) of imaging (87%), whether CM hemorrhage should be clinically symptomatic (73%), and whether hemorrhage had to extend outside the CM or not (47%). We define a CM hemorrhage as requiring acute or subacute onset symptoms (any of: headache, epileptic seizure, impaired consciousness, or new/worsened focal neurological deficit referable to the anatomic location of the CM) accompanied by radiological, pathological, surgical, or rarely only cerebrospinal fluid evidence of recent extra- or intralesional hemorrhage. The definition includes neither an increase in CM diameter without other evidence of recent hemorrhage, nor the existence of a hemosiderin halo.
A consistent approach to clinical and brain imaging classification of CM hemorrhage will improve the external validity of future CM research.
脑海绵状血管畸形（CMs）可导致颅内出血，但其报道的发生率有所不同，部分原因在于研究设计。为提高未来研究的有效性，我们旨在制定一个关于CM出血的可靠定义。
我们系统检索了已发表的文献（截至2007年6月1日的Ovid Medline和Embase），以查找在对≥20例患有CM的参与者进行未经治疗的临床病程研究中所使用的CM出血定义，为在血管瘤联盟科学研讨会上就CM出血的临床和影像学特征制定共识声明提供参考。
对1426篇关于人类CMs的出版物进行系统评价后，发现有15项研究符合我们的纳入标准。尽管14项（93%）研究给出了CM出血的定义，但在影像学的确诊类型（87%）、CM出血是否应具有临床症状（73%）以及出血是否必须扩展至CM之外（47%）等方面的数据并不完整。我们将CM出血定义为需要有急性或亚急性起病的症状（以下任何一种：头痛、癫痫发作、意识障碍或与CM解剖位置相关的新出现或加重的局灶性神经功能缺损），同时伴有近期病灶外或病灶内出血的放射学、病理学、手术学证据，或很少情况下仅为脑脊液证据。该定义既不包括无近期出血其他证据的CM直径增加，也不包括含铁血黄素环的存在。
对CM出血进行临床和脑影像学分类的一致方法将提高未来CM研究的外部有效性。
