Living with a Brain AVM: A Quality of Life Assessment.

Péter Orosz,Ágnes Vadász,Dániel Sándor Veres,István Gubucz,Sándor Nardai,Zsolt Berentei,Balázs Kis,István Szikora

doi:10.1007/978-3-030-63453-7_10

Abstract

Brain arteriovenous malformations (AVM) are uncommon vascular lesions with the risk of hemorrhage, epileptic seizures, neurological deficits, and headache. Comparing the risks of the natural history and that of preventive treatment, a recent study has found observation more beneficial than treatment for unruptured AVMs. This study, however, did not consider the long-term impact of carrying a brain AVM on everyday activities. In this study we analyzed the Quality Of Life (QOL) of patients with untreated AVMs, a measure increasingly used in clinical trials to asses this kind of impact. We enrolled 36 patients with unruptured, untreated brain AVM from our hospital database and measured their QOL retrospectively using the EQ-5D-5L questionnaire. As a control group we used the results of the Research Report, a nationwide study based on the quality of life of 5534 healthy Hungarians in 2002. Due to the low number of cases, statistical analysis could not be made. Headache proved to be the most common AVM-related sign in our cohort (40%, n=17), with a female predominance; neurological deficit was detected in 33% (n=14), while epileptic seizures occurred in 26% (n=11), more commonly affecting male subjects. Anxiety and discomfort seemed to be the most prevalent influencing factors on QOL, especially in the youngest age group (18-34years). Female subjects showed a greater dependence than men in all age groups, though males had a more significant impairment in their usual activities. Older patients were affected more significantly in their self-care and usual activities compared with the younger population. Untreated AVMs have a significant negative impact on patients carrying unruptured brain AVMs, as proved by QOL assessment. Beside neurological deficits, this impact should also be considered in the therapeutic decision.

Highlights

Arteriovenous malformations (AVM) are considered to be sporadic congenital vascular lesions, consisting of abnormal blood vessels forming direct connections between arteries and veins without capillary network
Cerebral AVMs can be asymptomatic, but when they are symptomatic, patients can present with intracranial hemorrhage (ICH), seizures, neurological deficits, and headache [3, 4]
Headache was reported to be associated with cerebral AVM in 17–50% of cases [9], while neurological deficits may be present in 3–10% [10]

Summary

Introduction

Arteriovenous malformations (AVM) are considered to be sporadic congenital vascular lesions, consisting of abnormal blood vessels forming direct connections between arteries and veins without capillary network. Brain AVMs affect 0.1% of the population [1] with an incidence of 1.3 per 100,000 persons a year [2]. Cerebral AVMs can be asymptomatic, but when they are symptomatic, patients can present with intracranial hemorrhage (ICH), seizures, neurological deficits, and headache [3, 4]. Hemorrhages are usually intraparenchymal, but subarachnoid location is common: brain AVMs are responsible for 9% of subarachnoid hemorrhages [5] and represents the leading cause of ICH in young adults [4]. Patients with a history of ruptured AVM are at higher risk of hemorrhage than those without it. The 5-year seizure risk for asymptomatic patients with AVM is 8%, when presenting with ICH or focal neurologic deficits the same risk rises to 23% [8]. Headache was reported to be associated with cerebral AVM in 17–50% of cases [9], while neurological deficits may be present in 3–10% [10]. Mortality rates range between 0.7% and 2.9% per year [11]

Methods

Results

Conclusion