Morbidity of Intracranial Hemorrhage in Patients With Cerebral Arteriovenous Malformation

To the Editor: The Columbia-Presbyterian Medical Center Arteriovenous Malformation Study Project has made, and continues to make, a significant contribution to our understanding of arteriovenous malformations of the brain. In the recent contribution of Hartmann et al,1 a number of interesting observations were made with regard to hemorrhage. The first is the high incidence among those that bleed of subarachnoid and intraventricular hemorrhage. Only 54% of initial hemorrhages and 49% of follow-up hemorrhage were intraparenchymal. This is at considerable variance with our experience at the Northern and Western Medical School, The University of Sydney, where we have followed all arteriovenous malformations (AVMs) seen since 1991, and of 114 patients presenting with hemorrhage, 82% have a significant intraparenchymal component. One is left with the feeling from this article that hemorrhage from AVMs is relatively benign. However, it must be borne in mind that this is a specially selected subset …