Shotar Eimad, Sourour Nader-Antoine, Premat Kevin, Haffaf Idriss, Ghazanfari Sam, Jacquens Alice, Nouet Aurélien, Lenck Stéphanie, Chiras Jacques, Degos Vincent, Clarençon Frédéric
Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.
Sorbonne Université, Paris, France.
Clin Neuroradiol. 2020 Jun;30(2):305-312. doi: 10.1007/s00062-019-00771-7. Epub 2019 Mar 13.
Non-traumatic acute subdural hematomas (SDH) are rare and have seldom been reported in ruptured brain arteriovenous malformations (BAVM). The aim of this study was to report the frequency of acute SDH in BAVM-related hemorrhage and to determine the relationship of SDHs with BAVM angioarchitectural features.
This was a retrospective monocentric study of patients admitted for BAVM rupture between 2003 and 2017. Patients with rupture complicating or closely following partial embolization procedures were excluded. Univariate followed by multivariate logistic regression analysis was used to determine factors significantly and independently associated with SDHs and distal flow-related aneurysms.
A total of 181 patients with 188 BAVM ruptures admitted during the study period were included, eleven cases of acute SDH were identified (6%) and 2 cases of isolated SDH were found. The presence of a distal flow-related aneurysm was the only feature independently and significantly associated with SDH (odds ratio [OR] 8.1, 95% confidence interval, CI 1.9-34.5, P = 0.003). Distal flow-related aneurysms were associated with proximal flow-related aneurysms (OR 28, 95%CI 4.9-163.8, P < 0.001), were more frequent in infratentorial BAVMs (OR 3.7, 95%CI 1.3-10.2, P = 0.01) and more often found in cases of acute SDH (OR 16.9, 95%CI 3.6-79.6, P < 0.001) and subarachnoid hemorrhage (SAH) (OR 4.5, 95%CI 1.7-12.2, P = 0.003).
Ruptured BAVMs can rarely present with acute SDH and SDH in ruptured BAVMs are often associated with distal flow-related aneurysms. This finding may impact acute management of ruptured BAVMs with SDH by eliciting an emergent and thorough imaging work-up to identify distal flow-related aneurysm(s), in turn leading to treatment.
非创伤性急性硬膜下血肿（SDH）较为罕见，在破裂的脑动静脉畸形（BAVM）中鲜有报道。本研究旨在报告BAVM相关出血中急性SDH的发生率，并确定SDH与BAVM血管构筑特征之间的关系。
这是一项对2003年至2017年间因BAVM破裂入院患者的回顾性单中心研究。排除破裂并发或紧跟部分栓塞术后的患者。采用单因素分析，随后进行多因素逻辑回归分析，以确定与SDH和远端血流相关动脉瘤显著且独立相关的因素。
本研究共纳入181例患者，其中188次BAVM破裂，发现11例急性SDH（6%），2例孤立性SDH。远端血流相关动脉瘤的存在是与SDH独立且显著相关的唯一特征（比值比[OR]为8.1，95%置信区间[CI]为1.9 - 34.5，P = 0.003）。远端血流相关动脉瘤与近端血流相关动脉瘤相关（OR为28，95%CI为4.9 - 163.8，P < 0.001），在幕下BAVM中更常见（OR为3.7，95%CI为1.3 - 10.2，P = 0.01），在急性SDH病例中更常发现（OR为16.9，95%CI为3.6 - 79.6，P < 0.001），在蛛网膜下腔出血（SAH）病例中也更常发现（OR为4.5，95%CI为1.7 - 12.2，P = 0.003）。
破裂的BAVM很少出现急性SDH，且破裂BAVM中的SDH常与远端血流相关动脉瘤有关。这一发现可能会影响伴有SDH的破裂BAVM的急性处理，通过进行紧急且全面的影像学检查以识别远端血流相关动脉瘤，进而进行治疗。
