Objective: Cerebral vasospasm (CVS) after a ruptured arteriovenous malformation (AVM) is rarely reported. This study is aimed at evaluating the predictive variables in AVM hemorrhage for CVS. Methods: A total of 160 patients with ruptured AVMs were admitted to our neurosurgical department from 2002 to 2018. The frequency of cerebral vasospasm after AVM hemorrhage and the impact of AVM-associated aneurysms were evaluated. We compared different bleeding patterns, such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) or a combination of both (ICH + SAH) and evaluated predictive variables for outcome in last follow-up. Results: A total of 62 (39%) patients had AAA, mostly located prenidal (75.8%). AVMs with ruptured aneurysms often resulted in ICH with SAH component (p < 0.001). Eighty-two patients (51%) presented a SAH component, and CVS occurred in 6 patients (7.3%), mostly due to a ruptured infratentorial AVM (p < 0.03). Infratentorial location and the amount of SAH component (p < 0.001) predicted the incidence of CVS significantly. Cerebral infarction was significantly associated with CVS (p < 0.02). Conclusion: SAH component and infratentorial location of ruptured AVMs may harbor a higher risk for CVS. Follow-up with angiographic imaging should be considered in patients with infratentorial AVM hemorrhage and delayed neurologic deterioration to rule out CVS.

Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980 Jan;6(1):1–9.
Gross BA, Du R. Vasospasm after arteriovenous malformation rupture. World Neurosurg. 78(3-4):300–5.
Jabbarli R, Reinhard M, Roelz R, Shah M, Niesen WD, Kaier K, et al. Early identification of individuals at high risk for cerebral infarction after aneurysmal subarachnoid hemorrhage: the BEHAVIOR score. J Cereb Blood Flow Metab. 2015 Oct;35(10):1587–92.
Schmidt JM, Rincon F, Fernandez A, Resor C, Kowalski RG, Claassen J, et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. 2007;7(1):10–7.
Rabinstein AA, Friedman JA, Weigand SD, McClelland RL, Fulgham JR, Manno EM, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004 Aug;35(8):1862–6.
Crowley RW, Medel R, Dumont AS, et al. Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke. 2011 Apr;42(4):919–23.
Darkwah Oppong M, Iannaccone A, Gembruch O, Pierscianek D, Chihi M, Dammann P, et al. Vasospasm-related complications after subarachnoid hemorrhage: the role of patients’ age and sex. Acta Neurochir (Wien). 2018 Jul;160(7):1393–400.
Inagawa T. Risk Factors for Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature. World Neurosurg. 2016 Jan;85:56–76.
Ryttlefors M, Enblad P, Ronne-Engström E, Persson L, Ilodigwe D, Macdonald RL. Patient Age and Vasospasm After Subarachnoid Hemorrhage. Neurosurgery. 2010 Oct;67(4):911–7.
Lagares A, Jiménez-Roldán L, Gomez PA, Munarriz PM, Castaño-León AM, Cepeda S, et al. Prognostic Value of the Amount of Bleeding After Aneurysmal Subarachnoid Hemorrhage: A Quantitative Volumetric Study. Neurosurgery. 2015 Dec;77(6):898–907.
Friedman JA, Goerss SJ, Meyer FB, Piepgras DG, Pichelmann MA, McIver JI, et al. Volumetric quantification of Fisher Grade 3 aneurysmal subarachnoid hemorrhage: a novel method to predict symptomatic vasospasm on admission computerized tomography scans. J Neurosurg. 2002 Aug;97(2):401–7.
Dinc N, Eibach M, Tritt S, Konczalla J, Seifert V, Marquardt G. Special Features in AVMs. Impact of Draining Veins on Hemorrhagic Presentation. Ann Vasc Med Res. 2017;4.
Locksley HB, Sahs AL, Knowler L. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg. 1966 May;24(5):922–32.
Perret G, Nishioka H. Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section VI. Arteriovenous malformations. An analysis of 545 cases of cranio-cerebral arteriovenous malformations and fistulae reported to the cooperative study. J Neurosurg. 1966 Oct;25(4):467–90.
Lobato RD, Gomez PA, Rivas JJ. Arteriovenous malformations and vasospasm. J Neurosurg. 1998 May;88(5):934–5.
Yanaka K, Hyodo A, Tsuchida Y, Yoshii Y, Nose T. Symptomatic cerebral vasospasm after intraventricular hemorrhage from ruptured arteriovenous malformation. Surg Neurol. 1992 Jul;38(1):63–7.
Maeda K, Kurita H, Nakamura T, Usui M, Tsutsumi K, Morimoto T, et al. Occurrence of severe vasospasm following intraventricular hemorrhage from an arteriovenous malformation. Report of two cases. J Neurosurg. 1997 Sep;87(3):436–9.
Pendharkar AV, Guzman R, Dodd R, Cornfield D, Edwards MS. Successful treatment of severe cerebral vasospasm following hemorrhage of an arteriovenous malformation. Case report. J Neurosurg Pediatr. 2009 Sep;4(3):266–9.
Platz J, Berkefeld J, Singer OC, Wolff R, Seifert V, Konczalla J, et al. Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms. Acta Neurochir (Wien). 2014 Nov;156(11):2025–34.
Stein KP, Wanke I, Forsting M, Zhu Y, Moldovan AS, Dammann P, et al. Associated aneurysms in supratentorial arteriovenous malformations: impact of aneurysm size on haemorrhage. Cerebrovasc Dis. 2015;39(2):122–9.
Stein KP, Wanke I, Forsting M, Oezkan N, Huetter BO, Sandalcioglu IE, et al. Associated Aneurysms in Infratentorial Arteriovenous Malformations: Role of Aneurysm Size and Comparison with Supratentorial Lesions. Cerebrovasc Dis. 2016;41(5–6):219–25.
Flores BC, Klinger DR, Rickert KL, Barnett SL, Welch BG, White JA, et al. Management of intracranial aneurysms associated with arteriovenous malformations. Neurosurg Focus. 2014 Sep;37(3):E11.
Shakur SF, Amin-Hanjani S, Mostafa H, Charbel FT, Alaraj A. Hemodynamic Characteristics of Cerebral Arteriovenous Malformation Feeder Vessels With and Without Aneurysms. Stroke. 2015 Jul;46(7):1997–9.
Cagnazzo F, Brinjikji W, Lanzino G. Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment-a systematic review. Acta Neurochir (Wien). 2016 Nov;158(11):2095–104.
Pollock BE, Flickinger JC, Lunsford LD, Bissonette DJ, Kondziolka D. Factors that predict the bleeding risk of cerebral arteriovenous malformations. Stroke. 1996 Jan;27(1):1–6.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.