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PO-0293 Management Of Cerebral Arteriovenous Malformation With Haemorrhage
  1. A Scheibl1,
  2. M Tisdall2,
  3. Q Mok1
  1. 1PICU, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

Abstract

Background and aims We retrospectively analysed cases of cerebral haemorrhage from arteriovenous malformation (AVM), admitted to a PICU of a tertiary hospital to determine management strategies and outcome.

Methods Data were collected retrospectively from a departmental database between 2009 to 2014.

Results 10 patients, all previously fit and well presented with spontaneous cerebral haemorrhage in the context of previously undiagnosed AVM. Median age at diagnosis was 12,5 years (8–15 years). (7 male, 3 female)

All patients presented with headache and decrease in Glasgow coma scale.

All patients had CT scan and angiogram as part of their initial evaluation and MRI for follow-up. Intracranial pressure monitoring devices were inserted in all patients and 5 required emergency craniotomy for haemorrhage evacuation. 6 required embolisation and 4 underwent gamma knife stereotactic radio surgery.

5 patients needed inotropic support with nor adrenaline during the first 24–36 h, 6 developed arterial hypertension during their PICU stay.

Median length of stay in PICU 9,5 days (3–19 days). Median length of invasive ventilation 7 days (2–16 days), 1 patient received a tracheostomy after several failed extubation trials.

Follow up after six months – one year showed seven patients with improving neurological signs, mostly hemiparesis, ataxia and diplopía. Two were asymptomatic and one patient has not reached the six month follow-up yet.

Conclusions Treatment of cerebral haemorrhage in context of arteriovenous malformation includes a multidisciplinary approach with satisfactory results in neurological outcome on follow-up.

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