Shotar Eimad, Pistocchi Silvia, Haffaf Idriss, Bartolini Bruno, Jacquens Alice, Nouet Aurélien, Chiras Jacques, Degos Vincent, Sourour Nader-Antoine, Clarençon Frédéric
Paris VI University, Pierre et Marie Curie, Paris, France.
Cerebrovasc Dis. 2017;44(5-6):304-312. doi: 10.1159/000479120. Epub 2017 Oct 3.
Brain arteriovenous malformations (BAVMs) are a leading cause of intracranial hemorrhage in young adults. This study aimed to identify individual predictive factors of early rebleeding after BAVM rupture and determine its impact on prognosis.
Early rebleeding was defined as a spontaneous intracranial hemorrhage within 30 days of BAVM rupture in patients with nonobliterated BAVMs. One hundred fifty one patients with 158 BAVM hemorrhagic events admitted to a tertiary care center during 14 years were included. Univariate followed by multivariate logistic regression was performed to assess the impact of early rebleeding on in-hospital mortality and modified Rankin Scale (mRS) score beyond 3 months and to identify independent predictors of early rebleeding.
Eight early rebleeding events were observed, 6 of which occurred during the first 7 days. Early rebleeding was independently and significantly associated with poor outcome (mRS ≥3 beyond 3 months, p = 0.004) but not with in-hospital mortality (p = 0.9). Distal flow-related aneurysms (p = 0.009) and altered consciousness with a Glasgow coma scale score of 3 (p = 0.01) were independently associated with early rebleeding.
Early rebleeding is a severe complication that can occur after BAVM-related hemorrhage. Distal flow-related aneurysms and initial altered consciousness are associated with early rebleeding.
脑动静脉畸形（BAVMs）是年轻成年人颅内出血的主要原因。本研究旨在确定BAVM破裂后早期再出血的个体预测因素，并确定其对预后的影响。
早期再出血定义为未闭塞的BAVM患者在BAVM破裂后30天内发生的自发性颅内出血。纳入了14年间在一家三级医疗中心收治的151例发生158次BAVM出血事件的患者。进行单因素分析，随后进行多因素逻辑回归分析，以评估早期再出血对3个月后院内死亡率和改良Rankin量表（mRS）评分的影响，并确定早期再出血的独立预测因素。
观察到8例早期再出血事件，其中6例发生在头7天内。早期再出血与不良预后（3个月后mRS≥3，p = 0.004）独立且显著相关，但与院内死亡率无关（p = 0.9）。远端血流相关动脉瘤（p = 0.009）和格拉斯哥昏迷量表评分为3的意识改变（p = 0.01）与早期再出血独立相关。
早期再出血是BAVM相关出血后可能发生的严重并发症。远端血流相关动脉瘤和初始意识改变与早期再出血有关。
