BACKGROUND Although it is well characterized in aneurysmal subarachnoid hemorrhage, vasospasm is exceedingly rare following cerebral arteriovenous malformation (AVM) rupture. Subsequently, this complication is poorly characterized with regard to delayed cerebral ischemia (DCI). We review cases of ruptured AVM to assess the frequency and severity of vasospasm on cerebral angiography, and DCI. SUMMARY We reviewed our institutional database of acute intracranial hemorrhages between 2005 and 2014. We identified patients with cerebral AVM rupture and evidence of vasospasm, which was confirmed with digital subtraction angiography (DSA). Cerebral angiograms were evaluated by 2 blinded neurointerventionalists for vasospasm. Statistical analyses were conducted on the angiographic results and variables of interest to determine predictors and associations of vasospasm and DCI. Thirty-six patients with acute intracranial hemorrhage due to ruptured cerebral AVM subsequently underwent cerebral angiography. The interrater reliability for vasospasm was 0.81. The incidence of vasospasm was 13.9% and the incidence of subsequent DCI was 11.1%. A significant relationship existed between isolated intraventricular hemorrhage and vasospasm (p = 0.001) and subsequent DCI (p = 0.006). Radiographic vasospasm was associated with DCI in 80% of the patients (p < 0.0001). No statistical significance existed between subarachnoid hemorrhage and the development of vasospasm or DCI (p = 1.000 and p = 0.626, respectively). All differences were significant at a 99% level of significance. KEY MESSAGE In cases of ruptured AVM, isolated intraventricular hemorrhage appears to be an independent risk factor for vasospasm and DCI. Vasospasm must be considered during late neurological deterioration following AVM hemorrhage, especially in the setting of isolated intraventricular hemorrhage.

中文翻译：

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孤立性脑室内出血与脑血管痉挛和动静脉畸形破裂后迟发性脑缺血有关。

背景尽管在动脉瘤性蛛网膜下腔出血中具有很好的特征，但脑动静脉畸形 (AVM) 破裂后血管痉挛极为罕见。随后，这种并发症在迟发性脑缺血 (DCI) 方面的特征很差。我们回顾了 AVM 破裂的病例，以评估脑血管造影和 DCI 中血管痉挛的频率和严重程度。总结 我们回顾了我们在 2005 年至 2014 年间的急性颅内出血机构数据库。我们确定了有脑 AVM 破裂和血管痉挛证据的患者，这通过数字减影血管造影 (DSA) 得到证实。脑血管造影由 2 位盲法神经介入医师评估血管痉挛。对血管造影结果和感兴趣的变量进行统计分析，以确定血管痉挛和 DCI 的预测因子和关联。36 例因脑 AVM 破裂导致急性颅内出血的患者随后接受了脑血管造影。血管痉挛的评估者间信度为 0.81。血管痉挛的发生率为13.9%，随后发生DCI的发生率为11.1%。孤立的脑室内出血和血管痉挛 (p = 0.001) 和随后的 DCI (p = 0.006) 之间存在显着关系。80% 的患者影像学血管痉挛与 DCI 相关（p < 0.0001）。蛛网膜下腔出血与血管痉挛或 DCI 的发展之间不存在统计学意义（分别为 p = 1.000 和 p = 0.626）。所有差异均在 99% 的显着性水平上显着。关键信息 在 AVM 破裂的情况下，孤立的脑室内出血似乎是血管痉挛和 DCI 的独立危险因素。在 AVM 出血后的晚期神经功能恶化期间必须考虑血管痉挛，特别是在孤立的脑室内出血的情况下。