Abstract
BackgroundBrain arteriovenous malformations (AVMs) consist of abnormal connections between arteries and veins via an interposing nidus. While hemorrhage is the most common presentation, unruptured AVMs can present with headaches, seizures, neurological deficits, or be found incidentally. It remains unclear as to what AVM characteristics contribute to pain generation amongst unruptured AVM patients with headaches.MethodsTo assess this relationship, the current study evaluates angiographic and clinical features amongst patients with unruptured brain AVMs presenting with headache. Loyola University Medical Center medical records were queried for diagnostic codes corresponding to AVMs. In patients with unruptured AVMs, we analyzed the correlation between the presenting symptom of headache and various demographic and angiographic features.ResultsOf the 144 AVMs treated at our institution between 1980 and 2017, 76 were unruptured and had sufficient clinical data available. Twenty-three presented with headaches, while 53 patients had other presenting symptoms. Patients presenting with headache were less likely to have venous stenosis compared to those with a non-headache presentation (13 % vs. 36 %, p = 0.044).ConclusionsOur study suggests that the absence of venous stenosis may contribute to headache symptomatology. This serves as a basis for further study of correlations between AVM angioarchitecture and symptomatology to direct headache management in AVM patients.
Highlights
Brain arteriovenous malformations (AVM) consist of abnormal connections between arteries and veins by way of an interposing nidus.[1]
Amongst the 83 unruptured AVM patients managed at our institution, 76 patients had their initial complaint documented and had angiograms available for review
Twenty-three (30 %) of the 76 patients with unruptured AVMs presented with headache
Summary
Loyola University Medical Center (LUMC) is an academic medical center and tertiary referral center for stroke and cerebrovascular disease in Maywood, Illinois with neurosurgical, radiation oncology, and interventional neuroradiology expertise. LUMC electronic medical record was queried for ICD-9 (747.81) and ICD-10 (Q28.2 and Q28.3) codes corresponding to vascular malformations and Current Procedural Terminology (CPT) codes for AVM treatment (61,680, 61,682, 61,684, 61,686, 61,690, and 61,692). Individual patient charts were reviewed to confirm an AVM diagnosis by angiographic or pathologic criteria. Variables extracted from the medical record included patient demographics of age at diagnosis, sex, and race. In cases of non-uniformity of venous caliber, the diameter of the draining vein at the exit from the nidus was used. Percent venous stenosis was defined as the narrowest diameter of a draining vein divided by either the largest diameter of the vein just proximal to the stenosis or the diameter of the vein as it exited the nidus. Patients with an unruptured AVM presenting with headache as the initial complaint were used as the dependent value. All analyses were performed with SAS 9.4 (Cary, NC) and two-sided p-value < 0.05 were deemed statistically significant
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