TY  - JOUR
A1  - Dinc, Nazife
A1  - Won, Sae-Yeon
A1  - Brawanski, Nina
A1  - Eibach, Michael Bernd
A1  - Quick-Weller, Johanna
A1  - Konczalla, Jürgen
A1  - Berkefeld, Joachim
A1  - Seifert, Volker
A1  - Marquardt, Gerhard
T1  - Differences in bleeding patterns and outcome after intracerebral hemorrhage due to vascular malformations
T2  - PLoS one
N2  - Background: Atypical intracerebral hemorrhage is a common form of primary manifestation of vascular malformations.
Objective: The aim of the present study is to determine clues to the cause of bleeding according to hemorrhage pattern (lobar, basal ganglia, infratentorial).
Methods: We retrospectively evaluated 343 consecutive neurosurgical patients with intracerebral hemorrhage (ICH), who were admitted to our neurosurgical department between 2006 and 2016. The study cohort includes only neurosurgical patients. Patients who underwent treatment by neurologists are not represented in this study. We assessed location of hemorrhage, hematoma volumes to rule out differences and predicitve variables for final outcome.
Results: In 171 cases (49.9%) vascular malformations, such as arteriovenous malformations (AVMs), cavernomas, dural fistulas and aneurysms were the cause of bleeding. 172 (50.1%) patients suffered from an intracerebral hemorrhage due to amyloid angiopathy or long standing hypertension. In patients with infratentorial hemorrhage a malformation was more frequently detected as in patients with supratentorial hemorrhage (36% vs. 16%, OR 2.9 [1.8;4.9], p<0.001). Among the malformations AVMs were most common (81%). Hematoma expansion was smaller in vascular malformation than non-malformation caused bleeding (24.1 cm3 vs. 64.8 cm3, OR 0.5 [0.4;0.7], p < 0.001,). In 6 (2.1%) cases diagnosis remained unclear. Final outcome was more favorable in patients with vascular malformations (63% vs. 12%, OR 12.8 [4.5;36.2], p<0.001).
Conclusion: Localization and bleeding patterns are predictive factors for origin of the hemorrhage. These predictive factors should quickly lead to appropriate vascular diagnostic measures. However, due to the inclusion criteria the validity of the study is limited and multicentre studies with further testing in general ICH patients are required.
KW  - Hemorrhage
KW  - Antiplatelet therapy
KW  - Angiography
KW  - Death rates
KW  - Neuroimaging
KW  - Diagnostic medicine
KW  - Magnetic resonance imaging
KW  - Multivariate analysis
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/50325
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-503251
SN  - 1932-6203
N1  - Copyright: © 2019 Dinc et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
VL  - 14
IS  - (5): e0217017
SP  - 1
EP  - 13
PB  - PLoS
CY  - Lawrence, Kan.
ER  -