Differences between intracranial vascular malformation types in the characteristics of their presenting haemorrhages: prospective, population-based study
- C Cordonnier1,
- R Al-Shahi Salman1,
- J J Bhattacharya2,
- C E Counsell3,
- V Papanastassiou2,
- V Ritchie4,
- R C Roberts5,
- R J Sellar1,
- C Warlow1,
- SIVMS Collaborators*
- 1Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
- 2Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
- 3Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
- 4Fauldhouse Health Centre, Fauldhouse, Edinburgh, UK
- 5Department of Neurology, Ninewells Hospital and Medical School, Dundee, UK
- Dr Rustam Al-Shahi Salman, Bramwell Dott Building, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK;
- Received 22 December 2006
- Revised 28 March 2007
- Accepted 21 April 2007
- Published Online First 8 May 2007
Objective: To determine the imaging and demographic characteristics of intracranial haemorrhages, which are subsequently found to be due to an underlying intracranial vascular malformation (IVM).
Methods: We compared the demographic and brain imaging characteristics of adults presenting with intracranial haemorrhage, subsequently found to be due to a brain arteriovenous malformation (BAVM), dural arteriovenous fistula (DAVF) or cavernous malformation (CM) in a prospective, population-based cohort of adults diagnosed for the first time with an IVM (The Scottish IVM Study (SIVMS)).
Results: Of the 141 adults in SIVMS who presented with intracranial haemorrhage, those with CMs presented at a younger age and were less handicapped. A total of 115 (82%) had intracerebral haemorrhage (ICH) with or without subarachnoid, intraventricular or subdural extension. ICH without extension into other compartments accounted for all CM bleeds, but only 50% of BAVM and DAVF bleeds. Median haematoma volumes differed (Kruskal–Wallis, p<0.0001): ICH due to BAVM (16.0 cm3, inter-quartile range (IQR) 4.7 to 42.0) and DAVF (14.1 cm3, IQR 4.9 to 21.5) were similar, but CM haematoma volumes were smaller (median 1.8 cm3, IQR 1.3 to 4.3). These findings were robust in sensitivity analyses. Small haematoma volumes occurred among all IVM types; the largest haematoma volume due to CM was 12 cm3, and volumes of >34 cm3 were only due to BAVM.
Conclusions: Intracranial haemorrhages found to be due to IVMs differ in adults’ age of presentation and clinical severity, as well as the volume and distribution of the haematoma within the brain compartments.
- intracranial haemorrhage
- arteriovenous malformation
- cavernous malformation
- dural arteriovenous fistula
Competing interests: This study was funded by the Medical Research Council (Clinical Training Fellowship G84/5176 and Clinician Scientist Fellowship G108/613), The Chief Scientist Office of the Scottish Executive Health Department (Project Grants K/MRS/50/C2704 and CZB/4/35), and a Project Grant from the Stroke Association (TSA04/01). CC was funded by the European Neurological Society, the Journées de Neurologie de Langue Française, the Stevenson Exchange Scholarship and the Fondation Bettencourt Schueller.
Competing interests: None.