Abstract
IntroductionCerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs). Here, our purpose was to identify risk factors for cerebral vasospasm after BAVM rupture in patients requiring intensive care unit (ICU) admission.MethodsPatients admitted to our ICU from January 2003 to May 2010 for BAVM rupture were included in this observational study. Clinical, laboratory and radiological features from admission to ICU discharge were recorded. The primary endpoint was cerebral vasospasm by transcranial Doppler (TCD-VS) or cerebral infarction (CI) associated with vasospasm. Secondary endpoints included the Glasgow Outcome Scale (GOS) at ICU discharge.ResultsOf 2,734 patients admitted to our ICU during the study period, 72 (2.6%) with ruptured BAVM were included. TCD-VS occurred in 12 (17%) and CI in 6 (8%) patients. All patients with CI had a previous diagnosis of TCD-VS. A Glasgow Coma Scale score <8 was a risk factor for both TCD-VS (relative risk (RR), 4.7; 95% confidence interval (95% CI), 1.6 to 26) and CI (RR, 7.8; 95% CI, 0.1 to 63). Independent risk factors for TCD-VS by multivariate analysis were lower Glasgow Coma Scale score (odds ratio (OR) per unit decrease, 1.38; 95% CI, 1.13 to 1.80), female gender (OR, 4.86; 95% CI, 1.09 to 25.85), and younger age (OR per decade decrease, 1.39; 95% CI, 1.05 to 1.82). The risk of a poor outcome (GOS <4) at ICU discharge was non-significantly increased in the patients with TCD-VS (RR, 4.9; 95% CI, 0.7 to 35; P = 0.09). All six patients with CI had poor outcomes.ConclusionsThis is the first cohort study describing the incidence and risk factors for cerebral vasospasm after BAVM rupture. Larger studies are needed to investigate the significance of TCD-vasospasm and CI in these patients.
Highlights
Cerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs)
BAVM rupture was defined as subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), or intracerebral hematoma visualized on the admission computed tomography (CT) scan with concomitant BAVM visualization by digital subtraction angiography (DSA) or CTangiography
During the sevenyear study period, 2,734 patients were admitted to our neurosurgical intensive care unit (ICU) including 81 (3.0%) with BAVM rupture
Summary
Cerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs). Our purpose was to identify risk factors for cerebral vasospasm after BAVM rupture in patients requiring intensive care unit (ICU) admission. Cerebral vasospasm has been extensively studied following aneurismal subarachnoid hemorrhage (SAH) and has been reported after traumatic brain injury [1] or neurosurgery [2]. After aneurismal SAH, several risk factors present at admission have been identified, such as younger age, cigarette smoking, poor clinical grade, arterial hypertension, intracerebral hemorrhage, and thick cisternal clot [3,4,5]. Our aim was to identify risk factors for cerebral vasospasm present at admission to the intensive care unit (ICU) for intracerebral bleeding following BAVM rupture
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