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Critical Care
Published in: Critical Care 4/2011

Open Access 01-08-2011 | Research

Admission risk factors for cerebral vasospasm in ruptured brain arteriovenous malformations: An observational study

Authors: Vibol Chhor, Yannick Le Manach, Fréderic Clarençon, Aurélien Nouet, Jean-Louis Daban, Lamine Abdennour, Louis Puybasset, Thomas Lescot

Published in: Critical Care | Issue 4/2011

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Abstract

Introduction

Cerebral vasospasm is a well-documented complication of aneurismal subarachnoid hemorrhage but has not been extensively studied in brain arteriovenous malformations (BAVMs). Here, our purpose was to identify risk factors for cerebral vasospasm after BAVM rupture in patients requiring intensive care unit (ICU) admission.

Methods

Patients admitted to our ICU from January 2003 to May 2010 for BAVM rupture were included in this observational study. Clinical, laboratory and radiological features from admission to ICU discharge were recorded. The primary endpoint was cerebral vasospasm by transcranial Doppler (TCD-VS) or cerebral infarction (CI) associated with vasospasm. Secondary endpoints included the Glasgow Outcome Scale (GOS) at ICU discharge.

Results

Of 2,734 patients admitted to our ICU during the study period, 72 (2.6%) with ruptured BAVM were included. TCD-VS occurred in 12 (17%) and CI in 6 (8%) patients. All patients with CI had a previous diagnosis of TCD-VS. A Glasgow Coma Scale score <8 was a risk factor for both TCD-VS (relative risk (RR), 4.7; 95% confidence interval (95% CI), 1.6 to 26) and CI (RR, 7.8; 95% CI, 0.1 to 63). Independent risk factors for TCD-VS by multivariate analysis were lower Glasgow Coma Scale score (odds ratio (OR) per unit decrease, 1.38; 95% CI, 1.13 to 1.80), female gender (OR, 4.86; 95% CI, 1.09 to 25.85), and younger age (OR per decade decrease, 1.39; 95% CI, 1.05 to 1.82). The risk of a poor outcome (GOS <4) at ICU discharge was non-significantly increased in the patients with TCD-VS (RR, 4.9; 95% CI, 0.7 to 35; P = 0.09). All six patients with CI had poor outcomes.

Conclusions

This is the first cohort study describing the incidence and risk factors for cerebral vasospasm after BAVM rupture. Larger studies are needed to investigate the significance of TCD-vasospasm and CI in these patients.
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Metadata
Title
Admission risk factors for cerebral vasospasm in ruptured brain arteriovenous malformations: An observational study
Authors
Vibol Chhor
Yannick Le Manach
Fréderic Clarençon
Aurélien Nouet
Jean-Louis Daban
Lamine Abdennour
Louis Puybasset
Thomas Lescot
Publication date
01-08-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10345

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