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Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations

Heather J Fullerton1, Achal S Achrol, S Claiborne Johnston

  • 1Department of Neurology, University of California, San Francisco, CA 94143-0137, USA. fullertonh@neuropeds.ucsf.edu

Stroke
|September 6, 2005
PubMed

Insights

Children with brain arteriovenous malformations (BAVMs) do not face a higher risk of subsequent intracranial hemorrhage (ICH) compared to adults. In fact, pediatric BAVMs may offer a protective effect against future ICH events.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatric Neurology

Background:

  • Brain arteriovenous malformations (BAVMs) are vascular malformations in the brain.
  • A common clinical belief suggests children with BAVMs have a higher risk of intracranial hemorrhage (ICH) than adults.
  • This perceived risk influences treatment decisions, but supporting evidence is limited.

Purpose of the Study:

  • To investigate and compare the risk of subsequent intracranial hemorrhage (ICH) in pediatric versus adult patients diagnosed with brain arteriovenous malformations (BAVMs).
  • To evaluate the influence of initial presentation, particularly hemorrhagic presentation, on ICH risk in different age groups.

Main Methods:

  • A retrospective study analyzed BAVM cases from two institutions (UCSF and Kaiser Permanente) from 1993 to 2004.
  • Kaplan-Meier survival analysis was used to compare subsequent ICH rates between children (<20 years) and adults.
  • Cox proportional hazards models adjusted for factors including age at presentation and initial hemorrhagic presentation.

Main Results:

  • The study included 996 person-years for children and 3260 for adults.
  • Unadjusted analysis showed similar annual ICH rates: 2.0% for children and 2.2% for adults (P=0.82).
  • Children were more likely to have an initial ICH (P<0.001). After adjustment, children had lower subsequent ICH rates (HR 0.10; P=0.036).

Conclusions:

  • Children with BAVMs do not exhibit an increased risk of subsequent ICH compared to adults.
  • Pediatric BAVM patients may possess a relative protection against future ICH events.
  • Hemorrhagic presentation is a critical confounder in studies comparing ICH rates in pediatric versus adult BAVM populations.
Abstract

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