Majumdar Monica, Tan Lee A, Chen Michael
Rush Medical College, Chicago, Illinois, USA.
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
J Neurointerv Surg. 2016 Feb;8(2):163-7. doi: 10.1136/neurintsurg-2014-011517. Epub 2015 Jan 7.
An accurate understanding of the morbidity and mortality associated with brain arteriovenous malformation (AVM) hemorrhage is important in determining the management of unruptured AVMs. Recent studies suggest this morbidity to be lower than assumed. We sought to perform a detailed critical assessment of the morbidity associated with ruptured brain AVMs.
A retrospective chart review from a single-center tertiary care medical center was performed. Inclusion criteria were patients admitted with intracranial hemorrhage caused by a previously untreated AVM. Forty variables were analyzed including patient demographics, imaging findings, clinical course, and clinical examinations.
From 2008 to 2013, of the 51 patients who fit our inclusion criteria, we found admission National Institutes of Health Stroke Scale (NIHSS) scores of 0, 1-9, and ≥10 in 22%, 24%, and 55%, respectively. Hematoma location was parenchymal in 33%, intraventricular in 10%, subarachnoid in 4%, and combined in 53%. Deep venous drainage was present in 35% of cases and associated aneurysms were present in 37%. 43% underwent emergency hematoma evacuation while four patients died during their admission. Of those who survived, 74% had neurologic deficits upon discharge (NIHSS ≥1), with 25.5% of patients having a severe deficit (NIHSS ≥10). On follow-up, 55% were independent in their daily activities of living.
Our assessment of morbidity associated with brain AVM rupture is higher than previously assumed and reported. These results should be further validated in a larger, more representative sample. An accurate understanding of the morbidity associated with AVM rupture is important as more patients with unruptured brain AVMs seek consultation.
准确了解脑动静脉畸形（AVM）出血相关的发病率和死亡率对于确定未破裂AVM的治疗方案至关重要。近期研究表明，这种发病率低于此前的假设。我们试图对破裂脑AVM相关的发病率进行详细的批判性评估。
对一家单中心三级医疗中心进行回顾性病历审查。纳入标准为因先前未经治疗的AVM导致颅内出血而入院的患者。分析了40个变量，包括患者人口统计学、影像学表现、临床病程和临床检查。
2008年至2013年，符合我们纳入标准的51例患者中，我们发现入院时美国国立卫生研究院卒中量表（NIHSS）评分为0、1 - 9和≥10的患者分别占22%、24%和55%。血肿位置为脑实质内的占33%，脑室内的占10%，蛛网膜下腔的占4%，混合性的占53%。35%的病例存在深部静脉引流，37%存在相关动脉瘤。43%的患者接受了急诊血肿清除术，4例患者在住院期间死亡。存活患者中，74%出院时存在神经功能缺损（NIHSS≥1），25.5%的患者存在严重缺损（NIHSS≥10）。随访时，55%的患者日常生活能够自理。
我们对脑AVM破裂相关发病率的评估高于此前的假设和报道。这些结果应在更大、更具代表性的样本中进一步验证。随着更多未破裂脑AVM患者寻求咨询意见，准确了解AVM破裂相关的发病率非常重要。
