Vilalta J, Arikan F, Torne R, Najarro R, Lopez D, Rodriguez-Hernandez A, Gandara D, Banos P
Hospitals Vall d'Hebron, 08035 Barcelona, Espana.
Rev Neurol. 2017 Jun 16;64(12):538-542.
To determine the causes of mortality in cases of brain haemorrhage among patients with arteriovenous malformations (AVM) treated in a tertiary hospital.
The patients with AVM who died over the period 1990-2014 were selected from a prospective register of vascular malformations. Demographic aspects, localisation of the AVM, associated aneurysms and previous treatments were reviewed. Three main causes of death were established: initial bleeding/rebleeding, those related with the treatment of the AVM and other causes not related with AVM.
A total of 400 patients were treated for AVM, 216 (54%) with a ruptured AVM, of whom 26 (12.1%) died as a result of a brain haemorrhage. The mean age of the group of patients who died was 48.8 years (range: 8-78 years). Twenty (76.9%) were admitted in coma (Glasgow Coma Scale < 9). In five cases (19.2%), bleeding was due to an associated aneurysm. A very high percentage (38.5%) had the AVM in the posterior fossa. Three patients had previously received non-curative treatments for the AVM in other medical centres. Of the total number, six (23.1%) received endovascular/surgical treatment in our hospital, and we have assumed that, due to the indication or owing to the time in which it was carried out, the cause of death was treatment-related, although two young patients underwent surgery with bilateral mydriasis. One patient died due to an associated glioblastoma, and the others, 19 (76%), due to rebleeding or to the initial brain damage.
Knowing the causes of mortality can help improve the clinical outcome, above all in cases in which an early treatment could be indicated.
确定在一家三级医院接受治疗的患有动静脉畸形（AVM）的脑出血患者的死亡原因。
从血管畸形前瞻性登记册中选取1990年至2014年期间死亡的AVM患者。回顾人口统计学特征、AVM的位置、相关动脉瘤及既往治疗情况。确定了三个主要死亡原因：初次出血/再出血、与AVM治疗相关的原因以及与AVM无关的其他原因。
共有400例患者接受了AVM治疗，其中216例（54%）为破裂的AVM，其中26例（12.1%）因脑出血死亡。死亡患者组的平均年龄为48.8岁（范围：8至78岁）。20例（76.9%）入院时处于昏迷状态（格拉斯哥昏迷量表<9）。5例（19.2%）出血是由相关动脉瘤引起。后颅窝AVM的比例非常高（38.5%）。3例患者此前在其他医疗中心接受过非根治性AVM治疗。在总数中，6例（23.1%）在我院接受了血管内/手术治疗，我们认为，由于适应证或实施时间的原因，死亡原因与治疗相关，尽管有2例年轻患者在双侧瞳孔散大的情况下接受了手术。1例患者死于相关的胶质母细胞瘤，其他19例（76%）死于再出血或原发性脑损伤。
了解死亡原因有助于改善临床结局，尤其是在可能需要早期治疗的情况下。
