Background: Previously published single center studies suggest the morbidity associated with brain arteriovenous malformations (AVM) hemorrhage to be lower than assumed. Given the recent controversy over the appropriate management of unruptured brain AVMs, we performed a multi-center critical assessment of the morbidity associated with ruptured brain AVMs.
Methods: A retrospective chart review from tertiary care, urban, academic medical centers was performed. Inclusion criteria consisted of patients admitted for intracranial hemorrhage caused by a previously untreated AVM. Thirty-seven variables were analyzed, including patient demographics, imaging findings, clinical course and clinical exams.
Results: 101 patients from three medical centers dating from 2008-2014 met the inclusion criteria. Admission NIHSS scores of 0, 1-9 and ≥10 were 26%, 29% and 45% respectively. Hematoma location was parenchymal in 32%, intraventricular in 11%, subarachnoid in 5%, and combined in 52%. Deep venous drainage was present in 43% of cases, and associated aneurysms were present in 44%. Thirty-seven percent underwent emergent hematoma evacuation while 8 patients expired during their admission. At discharge, of those that survived, 69% had a NIHSS ≥ 1, and 23% had a NIHSS ≥ 10. At 90 day follow-up, 27% had a mRS ≥ 3. Patients with admission NIHSS ≥ 10 had significantly higher rates of midline shift, surgical hematoma evacuation, and follow-up mRS ≥ 3(p < 0.05).
Conclusion: This multicenter critical assessment of the morbidity associated with brain AVM rupture suggests poorer clinical outcomes than previously assumed and reported. Rupture morbidity should be considered alongside rupture risk and procedural risk when considering preventative anatomic treatment of unruptured brain AVMs.