What Is the Risk for Intracerebral Hemorrhage With Cavernous Malformations?

Mark J. Alberts, MD


March 16, 2016

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Hello, and welcome to this Medscape stroke update. My name is Dr Mark Alberts, vice chair of neurology at UT Southwestern Medical Center, Dallas, Texas.

Today I would like to talk to you about cavernous malformations. This is something we haven't talked about a lot recently.

In the February 2016 issue of Lancet Neurology, there was a very nice study done by Margaret Horne and colleagues.[1] It was a multicenter, multinational collaboration using individual patient data in a meta-analysis to evaluate the natural history of cavernous malformations. This was a large and important study. It included 1620 patients constituting approximately 5200 person-years of follow-up. The primary endpoint was the occurrence of intracerebral hemorrhage (ICH).

They did a Kaplan-Meier survival analysis to see what the outcomes were over 5 years of follow-up. Overall, what they found was that the rate of ICH over 5 years was about 4% for patients with a hemispheric cavernous malformation who did not have prior ICH or focal neurologic deficit. That rate of ICH went up to 8% if patients had a brainstem cavernous malformation and no ICH or focal neurologic deficit. The rate jumped up even higher to about 18% in patients who had a hemispheric location and a prior history of either ICH or focal neurologic deficit. Last, the rate of symptomatic ICH over 5 years peaked at approximately 31% for patients who presented with a brainstem cavernous malformation as well as ICH and/or a focal neurologic deficit.

What does this tell us? This tells us that the natural history of these cavernous malformations is not that benign and that the presenting symptoms and the location play an important role in the risk of these lesions becoming symptomatic again over the following 5 years.

Now, interestingly, the patients' initial age, gender, or the multiplicity of the cavernous malformations did not appear to play a role in the 5-year risk of having ICH.

So, there you have it. This was a fairly large study with extensive follow-up that was very well done and included patients from many different medical centers all over the world.

With this information, I think we can be better informed about the natural history of these lesions, especially about how they vary based on initial presentation as well as the location of the cavernous malformations.

Thank you for tuning in to this Medscape stroke update. Have a good day.


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