Racial Associations with Hemorrhagic Presentation in Cerebral Arteriovenous Malformations

Studies focusing on hemorrhagic presentation of brain arteriovenous malformations (AVMs) have largely limited their analysis to angiographic features. We report the importance of race/ethnicity as a clinical factor associated with hemorrhagic AVM presentation in addition to previously reported angiographic features.

Data were prospectively and retrospectively collected on patients (N = 194) during the period 1993-2010 who presented with a single intracranial AVM, and baseline characteristics were compared for hemorrhagic presentation versus nonhemorrhagic presentation. Features that were statistically significant in univariate analysis or clinically significant were included in a multivariate analysis.

The median age at presentation was 32 years; 37.2% of patients were male. Spetzler-Martin grades were I in 17.5%, II in 37.1%, III in 28.9%, IV in 14.9%, and V in 1.5%. Baseline characteristics that differed significantly between patients presenting with hemorrhage compared with patients without hemorrhage were the following: race (P < 0.01), AVM size (P < 0.01), <3 feeding arteries (P = 0.01), absence of middle cerebral artery supply to AVM (P < 0.01), and AVM location (P < 0.01). Multivariate analysis revealed nonwhite race (odds ratio [OR] = 3.09 [95% confidence interval (CI) = 1.52, 6.44], P < 0.01); smaller AVM size (OR = 0.65 [95% CI = 0.19, 0.86], P < 0.01); and nonfrontal lobar (OR = 2.61 [95% CI = 1.2, 5.59], P = 0.02), basal ganglia (OR = 6.20 [95% CI = 1.52, 26.26], P = 0.01), or brainstem locations (OR = 4.41 [95% CI = 1.38, 14.92], P = 0.01) as factors associated with hemorrhagic presentation of brain AVMs.

To our knowledge, this is the first study demonstrating that race/ethnicity is significantly associated with hemorrhagic presentation of AVMs. We also confirmed previous observations that AVM size and location are associated with hemorrhagic presentation.