Predictors of Initial Presentation with Hemorrhage in Patients with Cavernous Malformations

Kelly D. Flemming, Shivram Kumar, Robert D. Brown, Giuseppe Lanzino

Research output: Contribution to journalArticle

Abstract

Background: Cavernous malformations (CMs) are low-flow vascular malformations of the central nervous system which are incidental or present with hemorrhage, seizures, or focal neurologic deficit (FND). Little is known about the time course of symptoms and the predictors of initial hemorrhagic presentation. Methods: Beginning in 2015, consecutive patients with radiologically confirmed CMs were recruited and completed a structured interview and written survey at baseline. Medical records and magnetic resonance imaging studies were reviewed. Data collected included the following: comorbid conditions, select medication use, and location of CMs. Logistic-regression models determined predictors of initial presentation with hemorrhage. Results: Of 202 patients, 58.4% were women (average age at diagnosis, 43.7 ± 16.5 years). Of the patients, 37.1%, 6.5%, and 14.8% presented with hemorrhage, FND, and seizures, respectively. CM was an incidental finding in 40.6%. Most patients presenting with hemorrhage (66.7%) deteriorated over 2–30 days after symptom onset. Brainstem location correlated with a higher likelihood of initial presentation with hemorrhage. Aspirin use and nonsteroidal anti-inflammatory drug use were more common in patients with CMs who did not present with hemorrhage. The effect of estrogen and aspirin was stronger in the sporadic compared with the familial form of CMs. In women, estrogen use increased the likelihood of presenting with hemorrhage. Conclusions: This prospective cohort study confirms brainstem location increases the likelihood of presenting with hemorrhage, but also supports a potential role of select medications on the initial clinical presentation of CMs. Further data from combined cohorts may aid in determining whether the influence of medications is different in familial versus sporadic form CMs.

Original languageEnglish (US)
JournalWorld neurosurgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Hemorrhage
Neurologic Manifestations
Aspirin
Brain Stem
Estrogens
Seizures
Central Nervous System Cavernous Hemangioma
Logistic Models
Central Nervous System Vascular Malformations
Incidental Findings
Medical Records
Cohort Studies
Anti-Inflammatory Agents
Magnetic Resonance Imaging
Prospective Studies
Interviews
Pharmaceutical Preparations

Keywords

  • Angioma
  • Antithrombotic
  • Aspirin
  • Cavernoma
  • Cavernous
  • Cavernous malformations
  • Estrogen
  • Hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Predictors of Initial Presentation with Hemorrhage in Patients with Cavernous Malformations. / Flemming, Kelly D.; Kumar, Shivram; Brown, Robert D.; Lanzino, Giuseppe.

In: World neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

@article{7329c78223364aa39eb99492af1ad6f8,
title = "Predictors of Initial Presentation with Hemorrhage in Patients with Cavernous Malformations",
abstract = "Background: Cavernous malformations (CMs) are low-flow vascular malformations of the central nervous system which are incidental or present with hemorrhage, seizures, or focal neurologic deficit (FND). Little is known about the time course of symptoms and the predictors of initial hemorrhagic presentation. Methods: Beginning in 2015, consecutive patients with radiologically confirmed CMs were recruited and completed a structured interview and written survey at baseline. Medical records and magnetic resonance imaging studies were reviewed. Data collected included the following: comorbid conditions, select medication use, and location of CMs. Logistic-regression models determined predictors of initial presentation with hemorrhage. Results: Of 202 patients, 58.4{\%} were women (average age at diagnosis, 43.7 ± 16.5 years). Of the patients, 37.1{\%}, 6.5{\%}, and 14.8{\%} presented with hemorrhage, FND, and seizures, respectively. CM was an incidental finding in 40.6{\%}. Most patients presenting with hemorrhage (66.7{\%}) deteriorated over 2–30 days after symptom onset. Brainstem location correlated with a higher likelihood of initial presentation with hemorrhage. Aspirin use and nonsteroidal anti-inflammatory drug use were more common in patients with CMs who did not present with hemorrhage. The effect of estrogen and aspirin was stronger in the sporadic compared with the familial form of CMs. In women, estrogen use increased the likelihood of presenting with hemorrhage. Conclusions: This prospective cohort study confirms brainstem location increases the likelihood of presenting with hemorrhage, but also supports a potential role of select medications on the initial clinical presentation of CMs. Further data from combined cohorts may aid in determining whether the influence of medications is different in familial versus sporadic form CMs.",
keywords = "Angioma, Antithrombotic, Aspirin, Cavernoma, Cavernous, Cavernous malformations, Estrogen, Hemorrhage",
author = "Flemming, {Kelly D.} and Shivram Kumar and Brown, {Robert D.} and Giuseppe Lanzino",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2019.09.161",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Predictors of Initial Presentation with Hemorrhage in Patients with Cavernous Malformations

AU - Flemming, Kelly D.

AU - Kumar, Shivram

AU - Brown, Robert D.

AU - Lanzino, Giuseppe

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Cavernous malformations (CMs) are low-flow vascular malformations of the central nervous system which are incidental or present with hemorrhage, seizures, or focal neurologic deficit (FND). Little is known about the time course of symptoms and the predictors of initial hemorrhagic presentation. Methods: Beginning in 2015, consecutive patients with radiologically confirmed CMs were recruited and completed a structured interview and written survey at baseline. Medical records and magnetic resonance imaging studies were reviewed. Data collected included the following: comorbid conditions, select medication use, and location of CMs. Logistic-regression models determined predictors of initial presentation with hemorrhage. Results: Of 202 patients, 58.4% were women (average age at diagnosis, 43.7 ± 16.5 years). Of the patients, 37.1%, 6.5%, and 14.8% presented with hemorrhage, FND, and seizures, respectively. CM was an incidental finding in 40.6%. Most patients presenting with hemorrhage (66.7%) deteriorated over 2–30 days after symptom onset. Brainstem location correlated with a higher likelihood of initial presentation with hemorrhage. Aspirin use and nonsteroidal anti-inflammatory drug use were more common in patients with CMs who did not present with hemorrhage. The effect of estrogen and aspirin was stronger in the sporadic compared with the familial form of CMs. In women, estrogen use increased the likelihood of presenting with hemorrhage. Conclusions: This prospective cohort study confirms brainstem location increases the likelihood of presenting with hemorrhage, but also supports a potential role of select medications on the initial clinical presentation of CMs. Further data from combined cohorts may aid in determining whether the influence of medications is different in familial versus sporadic form CMs.

AB - Background: Cavernous malformations (CMs) are low-flow vascular malformations of the central nervous system which are incidental or present with hemorrhage, seizures, or focal neurologic deficit (FND). Little is known about the time course of symptoms and the predictors of initial hemorrhagic presentation. Methods: Beginning in 2015, consecutive patients with radiologically confirmed CMs were recruited and completed a structured interview and written survey at baseline. Medical records and magnetic resonance imaging studies were reviewed. Data collected included the following: comorbid conditions, select medication use, and location of CMs. Logistic-regression models determined predictors of initial presentation with hemorrhage. Results: Of 202 patients, 58.4% were women (average age at diagnosis, 43.7 ± 16.5 years). Of the patients, 37.1%, 6.5%, and 14.8% presented with hemorrhage, FND, and seizures, respectively. CM was an incidental finding in 40.6%. Most patients presenting with hemorrhage (66.7%) deteriorated over 2–30 days after symptom onset. Brainstem location correlated with a higher likelihood of initial presentation with hemorrhage. Aspirin use and nonsteroidal anti-inflammatory drug use were more common in patients with CMs who did not present with hemorrhage. The effect of estrogen and aspirin was stronger in the sporadic compared with the familial form of CMs. In women, estrogen use increased the likelihood of presenting with hemorrhage. Conclusions: This prospective cohort study confirms brainstem location increases the likelihood of presenting with hemorrhage, but also supports a potential role of select medications on the initial clinical presentation of CMs. Further data from combined cohorts may aid in determining whether the influence of medications is different in familial versus sporadic form CMs.

KW - Angioma

KW - Antithrombotic

KW - Aspirin

KW - Cavernoma

KW - Cavernous

KW - Cavernous malformations

KW - Estrogen

KW - Hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=85074461106&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074461106&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2019.09.161

DO - 10.1016/j.wneu.2019.09.161

M3 - Article

C2 - 31605843

AN - SCOPUS:85074461106

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -