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World Neurosurg. 2016 Jul;91:73-80. doi: 10.1016/j.wneu.2016.03.080. Epub 2016 Apr 4.

Solitary Sporadic Cerebral Cavernous Malformations: Risk Factors of First or Recurrent Symptomatic Hemorrhage and Associated Functional Impairment.

Author information

1
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. Electronic address: philipp.dammann@uk-essen.de.
2
Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
3
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Abstract

OBJECTIVE:

To quantify the risk of a first or recurrent hemorrhage and the associated functional impairment in patients with sporadic solitary cerebral cavernous malformations (CCMs) and to investigate the potential risk factors.

METHODS:

We undertook an observational study (n = 199) of consecutive patients with the diagnosis of a single, sporadic CCM using clinical and magnetic resonance imaging follow-up to identify prospective hemorrhage events and associated functional impairment. We calculated the annual hemorrhage risk rates, calculated cumulative risks, and performed uni- and multivariate analysis to assess outcome predictors.

RESULTS:

There were 199 adults identified, and 712.5 person years of follow-up were analyzed. Overall annual rates of hemorrhage were 6.03%, 11.95%, and 1.03% in the complete cohort, in those presenting with previous hemorrhage, and in those without, respectively. The 5-year risk of hemorrhage was higher in those presenting with previous hemorrhage than those without (40.9%; 95% confidence interval [CI], 31.78-50.73 vs. 8.6%; 95% CI, 3.97-16.95; P < 0.0001) and in those with a brainstem CCM compared with nonbrainstem CCM (51.6%; 95% CI, 37.61-65.46 vs. 17.1%; 95% CI, 4.55-32.04; P < 0.0001). In the multivariate analysis, previous hemorrhage (odds ratio, 7.18; 95% CI, 1.8-28.11; P = 0.005), age less than 45 years (odds ratio, 2.61; 95% CI, 1.03-6.61; P = 0.042), and brainstem location (odds ratio, 7.44; 95% CI, 2.09-26.50; P = 0.002) increased the risk of hemorrhage. Of the patients, 30% showed a moderate or severe disability associated with a CCM hemorrhage (5-year risk of severe hemorrhage, 8.9%; 95% CI, 5.50-13.99).

CONCLUSIONS:

This study provides an estimate of symptomatic hemorrhage risk and the associated disability in patients with sporadic solitary CCM and an investigation of risk factors.

KEYWORDS:

Cerebral cavernous malformation; Functional impairment; Intracerebral hemorrhage; Natural history

PMID:
27058610
DOI:
10.1016/j.wneu.2016.03.080
[Indexed for MEDLINE]

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