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Published on: September 4, 2017
Long-term natural history of incidentally discovered cavernous malformations in a single-center cohort
S Arthur Moore1, Robert D Brown, Teresa J H Christianson
1Departments of Neurology and.
Insights
The prospective hemorrhage risk for asymptomatic intracerebral cavernous malformations (ICM) is very low, at 0.08% per patient-year. This finding aids in managing patients with incidental ICMs, particularly those with a single malformation.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Malformations
Background:
- Intracerebral cavernous malformations (ICMs) can be incidental findings or present with unclear symptoms.
- Understanding the prospective hemorrhage risk in these cases is crucial for patient management.
Purpose of the Study:
- To determine the prospective hemorrhage rate in patients with incidentally discovered or incidentally found intracerebral cavernous malformations (ICMs).
Main Methods:
- Retrospective identification of patients diagnosed with ICMs between 1989-1999.
- Prospective data collection via medical records, surveys, and death certificates for hemorrhage or seizure events.
- Calculation of prospective hemorrhage rate per patient-year.
Main Results:
- 107 patients provided 1311 patient-years of follow-up.
- A definitive prospective hemorrhage rate of 0.08% per patient-year was observed.
- No new seizures were reported in the follow-up period.
Conclusions:
- The risk of hemorrhage in asymptomatic intracerebral cavernous malformations (ICMs) is very low.
- Findings are valuable for managing patients with incidental ICMs, especially single lesions.
Object:
The aim of this study was to determine the prospective hemorrhage rate in a group of retrospectively identified patients in whom symptoms had an unclear relationship to an intracerebral cavernous malformation (ICM) or the malformation itself was an incidental finding.
Methods:
Patients with incidentally discovered ICMs diagnosed between 1989 and 1999 were identified from a previously published cohort. Those with ICMs having an unclear relationship with existing symptoms were also eligible for analysis. Updated clinical and radiographic data pertaining to symptomatic intracerebral hemorrhage related to the ICM or new seizures were obtained through medical chart review and mail survey. In select patients, phone calls were made and death certificates were obtained when possible. The prospective hemorrhage rate was calculated as the number of prospective hemorrhages divided by the number of patient-years of follow-up.
Results:
There were 1311 patient-years of follow-up among the 107 patients (49.5% male; mean age at diagnosis 52 years) eligible for this study. Forty-four patients died in the follow-up period, and the cause of death could be determined in 34 (77%). Two patients had a prospective hemorrhage, which was definitively related to the ICM in only one. Thus, the definitive prospective bleed rate was 0.08% per patient-year. No new seizures developed in any of the patients during the follow-up period.
Conclusions:
The risk of prospective hemorrhage in patients presenting asymptomatically with ICM is very low. This information can be useful in managing such patients and may be most applicable to those with a single ICM.
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