Cerebral arteriovenous malformation epidemiology

Cerebral arteriovenous malformation epidemiology

There has been increased detection of incidental Cerebral arteriovenous malformations (CAVM)s as result of the frequent use of advanced imaging techniques 1).

Common estimates of the prevalence rate vary widely, and their accuracy is questionable and are unfounded.

The prevalence of cerebral arteriovenous malformation (CAVM) in first-degree relatives (FDRs) of patients with a CAVM was increased but did not meet a prespecified criterion for a shared familial risk factor. In combination with the low absolute risk of a CAVM in FDRs, the results do not support screening of FDRs for CAVMs 2).

Since the most severe complication of an AVM is hemorrhagic stroke, most epidemiologic studies have concentrated on the hemorrhage risk and its risk factors 3).

Because of the rarity of the disease and the existence of asymptomatic patients, establishing a true prevalence rate is not feasible. Owing to variation in the detection rate of asymptomatic AVMs, the most reliable estimate for the occurrence of the disease is the detection rate for symptomatic lesions: 0.94 per 100,000 person-years (95% confidence interval, 0.57-1.30/100,000 person-years). This figure is derived from a single population-based study, but it is supported by a reanalysis of other data sources. The prevalence of detected, active (at risk) AVM disease is unknown, but it can be inferred from incidence data to be lower than 10.3 per 100,000 population. 4).

AVMs account for between 1 and 2% of all strokes, 3% of strokes in young adults, 9% of subarachnoid haemorrhages and, of all primary intracerebral haemorrhages, they are responsible for 4% overall, but for as much as one-third in young adults. AVMs are far less common causes of first presentations with unprovoked seizures (1%), and of people presenting with headaches in the absence of neurological signs (0.3%). At the time of detection, at least 15% of people affected by AVMs are asymptomatic, about one-fifth present with seizures and for approximately two-thirds of them the dominant mode of presentation is with intracranial haemorrhage. The limited high quality data available on prognosis suggest that long-term crude annual case fatality is 1-1.5%, the crude annual risk of first occurrence of haemorrhage from an unruptured AVM is approximately 2%, but the risk of recurrent haemorrhage may be as high as 18% in the first year, with uncertainty about the risk thereafter. For untreated AVMs, the annual risk of developing de novo seizures is 1%. There is a pressing need for large, prospective studies of the frequency and clinical course of AVMs in well-defined, stable populations, taking account of their prognostic heterogeneity 5).

According to reports, 0.1% of the population harbors an AVM 6) 7).

Both sexes are affected equally. AVMs are the leading cause of nontraumatic intracerebral hemorrhage in people less than 35 years old 8).

Most lesions reach attention in patients in their 40’s and 75% of the hemorrhagic presentations occur before the age of 50 years 9)

According to autopsy studies, only 12% of AVMs become symptomatic during life 10).


They are the most frequently encountered structural cause of spontaneous intracerebral hemorrhage in childhood, excluding hemorrhages of prematurity.

AVMs are seen more frequently on MRI with advancing age in children and young adults 11).

References

1) Ajiboye N, Chalouhi N, Starke RM, Zanaty M, Bell R. Cerebral arteriovenous malformations: evaluation and management. ScientificWorldJournal. 2014;2014:649036. doi: 10.1155/2014/649036. Epub 2014 Oct 15. Review. PubMed PMID: 25386610; PubMed Central PMCID: PMC4216697. 2) van Beijnum J, van der Worp HB, Algra A, Vandertop WP, van den Berg R, Brouwer PA, van der Sprenkel JW, Kappelle LJ, Rinkel GJ, Klijn CJ. Prevalence of brain arteriovenous malformations in first-degree relatives of patients with a brain arteriovenous malformation. Stroke. 2014 Nov;45(11):3231-5. doi: 10.1161/STROKEAHA.114.005442. Epub 2014 Sep 18. PubMed PMID: 25236872. 3) Laakso A, Hernesniemi J. Arteriovenous malformations: epidemiology and clinical presentation. Neurosurg Clin N Am. 2012 Jan;23(1):1-6. doi: 10.1016/j.nec.2011.09.012. Review. PubMed PMID: 22107853. 4) Berman MF, Sciacca RR, Pile-Spellman J, Stapf C, Connolly ES Jr, Mohr JP, Young WL. The epidemiology of brain arteriovenous malformations. Neurosurgery. 2000 Aug;47(2):389-96; discussion 397. Review. PubMed PMID: 10942012. 5) Al-Shahi R, Warlow C. A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults. Brain. 2001 Oct;124(Pt 10):1900-26. Review. PubMed PMID: 11571210. 6) , 9) Brown R. D., Jr., Wiebers D. O., Torner J. C., O’Fallon W. M. Frequency of intracranial hemorrhage as a presenting symptom and subtype analysis: a population-based study of intracranial vascular malformations in Olmsted County, Minnesota. Journal of Neurosurgery. 1996;85(1):29–32. doi: 10.3171/jns.1996.85.1.0029. 7) The Arteriovenous Malformation Study Group Arteriovenous malformations of the brain in adults. The New England Journal of Medicine. 1999;340(23):1812–1818. doi: 10.1056/NEJM199906103402307. 8) Ruíz-Sandoval J. L., Cantú C., Barinagarrementeria F. Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke. 1999;30(3):537–541. doi: 10.1161/01.STR.30.3.537. 10) McCormick W. E. Classification, pathology and natural history of angiomas of the central nervous system. Weekly Update: Neurology and Neurosurgery. 1978;14:2–7. 11) O’Lynnger TM, Al-Holou WN, Gemmete JJ, Pandey AS, Thompson BG, Garton HJ, Maher CO. The effect of age on arteriovenous malformations in children and young adults undergoing magnetic resonance imaging. Childs Nerv Syst. 2011 Aug;27(8):1273-9. doi: 10.1007/s00381-011-1434-9. Epub 2011 Mar 26. PubMed PMID: 21442267.

WhatsApp WhatsApp us
%d bloggers like this: