Recurrent Hemorrhage After Hemorrhagic Presentation In Patients With Arteriovenous Malformations Of The Brain: Frequency, Timing And Risk Factors

Gus Beute1, Walid Moudrous2, Karin Klijn2, Willem Jan van3, Patrick Hanssens4, Janneke van Beijnum2, Gabriel Rinkel2

1Tilburg, Netherlands 2 Department of Neurology 3 Department of Radiology 4Department of Neurosurgery

Keywords: arteriovenous malformation, hemorrhage, gamma knife, stroke, outcome

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     The timing and frequency of recurrent hemorrhages from brain arteriovenous malformations BAVMs are not well known. Nonetheless the therapy of BAVMs is based on preventing new intracranial hemorrhages, but the timing of therapy to prevent new hemorrhages is not well investigated.
     Our aim is to investigate the rate and timing of subsequent hemorrhages and determine patient and hemorrhage related risk factors.
     Patients with an untreated BAVM were retrospectively identified at the Universital Medical Center Utrecht (UMCU) and the Sint Elizabeth Hospital (SEH), who presented themselves with BAVM related hemorrhage or symptoms (epilepsy, headache or neurological deficit), incidental findings of a BAVM with BAVM related hemorrhage.
     For all patients demographic, clinical, morphological and treatment characteristics were collected. Survival analysis was made by using Kaplan-Meier life tables and uni- and multivariate logistic regression models based on Cox proportional hazard regression analysis.
     A total of 251 patients were included in our database. The total follow up period was 595.5 patients-years (mean 894.5 days; range 0-5528 days). Recurrent hemorrhage was identified in 29 patients (CI 0.08-0.16 P>0.001) of whom eight had a recurrent hemorrhage prior to therapy. The overall annual bleeding rate after the first hemorrhage was 4.87% and 4.81 % in the first year, while the annual bleeding rate declined with the subsequent follow up years till 0.78% in the fourth follow up year.
     This is a retrospective study.
     Our results suggest that the risk for recurrent hemorrhage is it highest in the first year after the initial hemorrhage and it diminishes with the subsequent follow up years.
     One of the most important risk factors is a delay in receiving treatment to obliterate the BAVM. Implications for the radiosurgical treatment will be discussed in view of the results and recurrent hemorrhages in the 250 cases treated with LGKS in Tilburg from 2002 to 2010.


Project Roles:

G. Beute (), W. Moudrous (), K. Klijn (), W. van (), P. Hanssens (), J. Beijnum (), G. Rinkel ()