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Hon JM, Bhattacharya JJ, Counsell CE, Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP, Al-Shahi Salman R. The Presentation and Clinical Course of Intracranial Developmental Venous Anomalies in Adults. Stroke 2009; 40:1980-5. [PMID: 19390075 DOI: 10.1161/strokeaha.108.533034] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Reported risks of hemorrhage from intracranial developmental venous anomalies (DVAs) vary, so we investigated this in a systematic review and population-based study.
Methods—
We systematically reviewed the literature (Ovid Medline and Embase to November 7, 2007) and selected studies of ≥20 participants with ≥1 DVA(s) that described their clinical presentation and/or their clinical course over a specified follow-up period. We also identified every adult first diagnosed with a DVA in Scotland from 1999 to 2003 and followed them in a prospective, population-based study.
Results—
Of 2068 articles detected by the literature search, 15 met our inclusion criteria and described clinical presentation, 8 of which also described the clinical course of DVAs. In the 15 studies of 714 people first presenting with a DVA, 61% were incidental findings, the mode of presentation was unclear in 23%, 6% presented with nonhemorrhagic focal neurological deficit, 6% had caused symptomatic hemorrhage, 4% were associated with epileptic seizure, and <1% were associated with infarction. In studies of the clinical course of 422 people with a DVA, the hemorrhage rate after first presentation ranged from 0% to 1.28% per year. In the population-based study of 93 adults with DVAs, 98% were incidental, 1% presented with symptomatic hemorrhage, and 1% presented with an infarct, but there were no symptomatic hemorrhages or infarcts in 492 person-years of follow-up (0% per person-year; 95% CI, 0% to 0.7%).
Conclusions—
Intracranial DVAs have a benign presentation and clinical course.
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Affiliation(s)
- Jennifer M.L. Hon
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Jo J. Bhattacharya
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Carl E. Counsell
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Vakis Papanastassiou
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Vaughn Ritchie
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Richard C. Roberts
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Robin J. Sellar
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Charles P. Warlow
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
| | - Rustam Al-Shahi Salman
- From the Division of Clinical Neurosciences (J.M.L.H., R.J.S., C.P.W., R.A.-S.S.), University of Edinburgh, Western General Hospital, Edinburgh, UK; the Institute of Neurological Sciences (J.J.B., V.P.), Southern General Hospital, Glasgow, UK; the Department of Neurology (C.E.C.), Aberdeen Royal Infirmary, Aberdeen, UK; Fauldhouse Health Centre (V.R.), Fauldhouse, Edinburgh, UK; and the Department of Neurology (R.C.R.), Ninewells Hospital and Medical School, Dundee, UK
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