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. 2024 Aug 23:15:1432687.
doi: 10.3389/fneur.2024.1432687. eCollection 2024.

Ultra-early neurological deterioration following a brain arteriovenous malformation rupture

Eimad Shotar  1   2 , Pierre-Marie Chiaroni  1   3 , Idriss Haffaf  1 , Jonathan Cortese  1 , Alice Jacquens  3   4 , Lorenzo Garzelli  1 , Julien Allard  1 , Mahmoud Elhorany  1   5 , Caroline Amouyal  4 , Bertrand Mathon  3   6 , Aurélien Nouet  6 , Kévin Premat  1 , Stéphanie Lenck  1 , Nader-Antoine Sourour  1 , Vincent Degos  3   4 , Frédéric Clarençon  1   3
Affiliations

Ultra-early neurological deterioration following a brain arteriovenous malformation rupture

Eimad Shotar et al. Front Neurol. .

Abstract

Purpose: This study aims to explore the impact of ultra-early neurological deterioration (U-END) on the outcome (mortality and poor neurological status) following a brain arteriovenous malformation (BAVM) rupture and identify determinants of U-END.

Methods: Patients with BAVM ruptures admitted to a single tertiary care center were retrospectively reviewed. U-END was defined as a worsening by two or more points on the Glasgow Coma Scale (GCS). U-END was tested as a potential predictor of in-hospital mortality and poor outcomes. Univariate and multivariate analyses were performed to identify determinants of U-END. Patients with U-END were also matched and compared with BAVM rupture controls presenting with a GCS close or equal to either their initial or their lowest GCS.

Results: A total of 248 patients with BAVM ruptures met the inclusion criteria, with 39 (15.7%) patients presenting with U-END. U-END was not associated with and was not an independent predictor of in-hospital mortality (12.8 vs. 10.5% in the rest of the study population; p = 0.67) or poor outcomes (39.5 vs. 36.9%; p = 0.77). The only independent determinants of U-END were hydrocephalus (OR 2.6 [95%CI, 1.1-6.4]; p = 0.03) and intraventricular hemorrhage (IVH; OR 3.5 [95%CI, 1.1-11.7]; p = 0.04). When compared to the initial GCS control group, U-END patients more often presented with IVH (89.5 vs. 64.1%; p = 0.009) and hydrocephalus (73 vs. 38.5%; p = 0.003). When compared to the lowest GCS control group, U-END patients had lower early S100B serum levels (0.35 ± 0.37 vs. 0.83 ± 1; p = 0.009) and a lower rate of poor outcome (39.5 vs. 64.9%; p = 0.03).

Conclusion: Ultra-early neurological deterioration in ruptured BAVMs did not result in increased mortality or poor outcomes and was most often related to IVH and hydrocephalus.

Keywords: arteriovenous malformation; deterioration; hemorrhage; hydrocephalus; rupture.

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Conflict of interest statement

FC reports conflict of interest (unrelated) with Medtronic, Guerbet, Balt Extrusion (payment for readings), and Codman Neurovascular (core lab). N-AS is consultant for Medtronic, Balt Extrusion, and Microvention (unrelated to the study). ES is principal investigator of a randomized controlled trial related to chronic subdural hematoma embolization financed by a PHRC-IR public grant (unrelated). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
BAVM, Brain arteriovenous malformation; GCS, Glasgow Coma Scale; U-END, Ultra-early neurological deterioration.
Figure 2
Figure 2
(A) Kaplan–Meier survival curve comparing patients with and without ultra-early neurological deterioration (U-END). (B,C) Receiver operating characteristic (ROC) curves comparing initial Glasgow Coma Scale (GCS) and lowest early GCS as predictors of in-hospital mortality (B) and poor neurological outcome (C). GCS, Glasgow Coma Scale; ROC, Receiver operating characteristic; and U-END, Ultra-early neurological deterioration.
See this image and copyright information in PMC

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