Leukocytosis at Presentation Is an Independent Predictor for Hemorrhage in Cerebral Cavernoma

Objective: Cerebral cavernous malformations (CCMs) are usually occult but can present with a symptomatic hemorrhage. Treatment recommendations for CCMs are still controversially discussed, as all CCMs have signs of chronic hemorrhage. The distinction of acute hemorrhage can be difficult, especially when patients only present with mild symptoms. Because of emerging evidence supporting inflammatory burden as a main avenue in the disease pathogenesis of CCMs, the aim of the present study was to investigate routine inflammatory parameters to support decision-making in ambiguous cases. Methods: A total of 87 patients who underwent CCM resection at the authors' institution between 2008 and 2021 were included in this study. Data were recorded retrospectively. Patients were dichotomized into two groups: those with acute hemorrhage and those without, as a control group (e.g., resection for seizure control). Inflammatory parameters included C-reactive Protein (CrP), White Blood Cell Count (WBC), Red Cell Distribution Width (RDW), and Mean Platelet Volume/Platelet Count Ratio (MPV/PC). Results: The receiver operating characteristic curve demonstrated moderate diagnostic accuracy for predicting acute hemorrhage from CCM based on WBC at admission (AUC: 0.74, 95%-CI: 0.63-0.84) with a cut-off of ≥6.595 G/L. The multivariable analysis confirmed that having a WBC > 6.595 G/L is an independent predictor for acute hemorrhage of CCM (adjusted odds ratio: 4.5, 95%-CI: 1.8-11.2, p < 0.001). Conclusions: A white blood cell count >6.595 G/L was significantly associated with acute hemorrhage in CCMs and appears to be a quick-to-use biomarker in controversial cases. Moreover, leukocytosis emphasizes the involvement of neuroinflammation in acute hemorrhage of CCM. Further investigations are needed to analyze the precise role of inflammation in CCM pathogenesis and its impact on treatment strategies.