HYPERTENSION, SMALL-SIZE, AND DEEP VENOUS DRAINAGE ARE ASSOCIATED WITH RISK OF HEMORRHAGIC PRESENTATION OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS

OBJECTIVE: To identify clinical and angiographic factors of cerebral a rteriovenous malformations (AVMs) associated with hemorrhage to improv e the estimation of the risks and help guide management in clinical de cision making. METHODS: We conducted a retrospective analysis of 100 c onsecutive adults who have presented during the past 3 years to our in stitution with cerebral AVMs. Angiographic and clinical parameters wer e evaluated using multivariate logistic regression analysis to analyze factors associated with hemorrhagic presentation. RESULTS: The group had a mean age of 37.8 years; 53% were men, 48% presented with intracr anial hemorrhage, and 40% presented with seizures. All 10 patients wit h cerebellar AVMs presented with hemorrhage. The following factors wer e independently associated with AVM hemorrhage: history of hypertensio n (P = 0.019; odds ratio [OR] = 5.36), nidal diameter <3 cm (P = 0.023 : OR = 4.60), and deep venous drainage (P = 0.009: OR = 5.77). Dural a rterial supply (P = 0.008; OR = 0.15) was independently associated wit h decreased risk of bleed. Location, nidal aneurysms, patient age, and smoking were not associated with increased or decreased bleeding risk . CONCLUSION: In this study, we found small AVM size and deep venous d rainage to be positively associated with AVM hemorrhage. Dural supply was associated with a decreased likelihood of hemorrhagic presentation . Hypertension was found to be the only clinical factor positively ass ociated with hemorrhage, a finding not previously reported. Smoking, a lthough associated with increased risk of aneurysmal subarachnoid hemo rrhage, was not associated with a higher risk of AVM hemorrhage.