Characteristics of brain arteriovenous malformations in patients presenting with nonhemorrhagic neurologic deficits

To identify the specific angioarchitectural characteristics of arteriovenous malformations (AVMs) that are associated with a clinical presentation of nonhemorrhagic neurologic deficits.

Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution. Twenty-four patients (7.9%) presented with neurologic deficits without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and neurological deficits at presentation.

When we compared the 24 (7.9%) patients with nonhemorrhagic neurological deficits with the 278 patients who did not experience neurologic deficits initially (total of 302 patients), female sex (P = 0.002), deep AVM location (P = 0.015), AVM size greater than 3 cm (P = 0.001), more than three arterial feeders present (P = 0.004), only perforating feeding artery (P = 0.007), the presence of more than three draining veins (P = 0.016), the presence of varices in the venous drainage (P = 0.013), and a Spetzler-Martin grade of III to V (P = 0.004) were statistically associated with neurological deficits. Patient age, eloquent location, deep venous drainage, venous drainage restriction, and coexisting aneurysms were not statistically associated with neurological deficits without hemorrhage.

The characteristics of AVM associated with nonhemorrhagic neurological deficits include female sex, deep AVM location, more than three arterial feeders, only perforating feeding artery, more than three draining veins, the presence of varices in the venous drainage, and a Spetzler-Martin grade of III to V.