Sudden Prehospital Deaths From Brain Arteriovenous Malformations: A Population-Based Study

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Existing mortality data for brain arteriovenous malformations (AVMs) are limited to hospital-based studies, leaving prehospital deaths unquantified.
• Unexpected deaths outside hospitals due to AVMs are not well-documented, necessitating population-based research.

Purpose of the Study:

• To determine the incidence and causes of AVM-related deaths in a large population, including those occurring outside of hospital settings.
• To investigate the hypothesis that AVMs rarely cause unexpected prehospital deaths, and that seizures are a more frequent cause than hemorrhage.

Main Methods:

• A population-based cross-sectional study was conducted in the Helsinki University Hospital (HUH) region from 1998-2015.
• Autopsy reports from the National Cause of Death Register and the Helsinki AVM Register were used to identify AVM-related prehospital deaths in both diagnosed and undiagnosed individuals.
• Age-standardized detection rates were calculated using European Standard Population (ESP) data.

Main Results:

• Six AVM-related prehospital deaths were identified: 4 in undiagnosed individuals and 2 in previously diagnosed patients.
• Epileptic seizures accounted for 4 of the 6 prehospital deaths, while hemorrhage caused 2.
• The incidence of AVM detection, including prehospital deaths, was 0.80 per 100,000 person-years.

Conclusions:

• AVM-related deaths occurring before hospital arrival are infrequent.
• Epileptic seizures are a more common cause of prehospital AVM-related death than hemorrhage.
• The majority of AVM-related fatalities occur within a hospital setting.