Neurological event prediction for patients with symptomatic cerebral cavernous malformation: the BLED2 score

 

 Well congratulations, you described a problem BUT DID NOTHING TO SOLVE IT. You all need to be fired. 

Neurological event prediction for patients with symptomatic cerebral cavernous malformation: the BLED₂ score

Alon Orlev MD^1,2, James Feghali MD², Gil Kimchi MD³, Moran Salomon MD⁴, Shani Berkowitz MS¹, Liat Oxman MD¹, Idan Levitan MD¹, Nachshon Knoller MD³, Eitan Auriel MD⁵, Judy Huang MD², Rafael J. Tamargo MD², and Sagi Harnof MD¹

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DOI link:

https://doi.org/10.3171/2021.8.JNS211321

Online Publication Date:

17 Dec 2021

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• ABSTRACT
• SUPPLEMENTARY MATERIALS

OBJECTIVE

Retrospective patient cohort studies have identified risk factors associated with recurrent focal neurological events in patients with symptomatic cerebral cavernous malformations (CCMs). Using a prospectively maintained database of patients with CCMs, this study identified key risk factors for recurrent neurological events in patients with symptomatic CCM. A simple scoring system and risk stratification calculator was then created to predict future neurological events in patients with symptomatic CCMs.

METHODS

This was a dual-center, prospectively acquired, retrospectively analyzed cohort study. Adult patients who presented with symptomatic CCMs causing focal neurological deficits or seizures were uniformly treated and clinically followed from the time of diagnosis onward. Baseline variables included age, sex, history of intracerebral hemorrhage, lesion multiplicity, location, eloquence, size, number of past neurological events, and duration since last event. Stepwise multivariable Cox regression was used to derive independent predictors of recurrent neurological events, and predictive accuracy was assessed. A scoring system based on the relative magnitude of each risk factor was devised, and Kaplan-Meier curve analysis was used to compare event-free survival among patients with different score values. Subsequently, 1-, 2-, and 5-year neurological event rates were calculated for every score value on the basis of the final model.

RESULTS

In total, 126 (47%) of 270 patients met the inclusion criteria. During the mean (interquartile range) follow-up of 54.4 (12–66) months, 55 patients (44%) experienced recurrent neurological events. Multivariable analysis yielded 4 risk factors: bleeding at presentation (HR 1.92, p = 0.048), large size ≥ 12 mm (HR 2.06, p = 0.016), eloquent location (HR 3.01, p = 0.013), and duration ≤ 1 year since last event (HR 9.28, p = 0.002). The model achieved an optimism-corrected c-statistic of 0.7209. All factors were assigned 1 point, except duration from last event which was assigned 2 points. The acronym BLED₂ summarizes the scoring system. The 1-, 2-, and 5-year risks of a recurrent neurological event ranged from 0.6%, 1.2%, and 2.3%, respectively, for patients with a BLED₂ score of 0, to 48%, 74%, and 93%, respectively, for patients with a BLED₂ score of 5.

CONCLUSIONS

The BLED₂ risk score predicts prospective neurological events in symptomatic CCM patients.

 

 

 

Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

 Well congratulations, you described a problem BUT DID NOTHING TO SOLVE IT. You all need to be fired.

Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

A Nomogram Approach to Risk Assessment

Li Ma

,

Shuo Zhang

,

Zongze Li

,

Chun-Xue Wu

,

Zhaozhao Wang

,

Lei Zhan

,

Qiang Hao

,

Hao Wang

,

Xun Ye

,

Xiaolin Chen

,

Ya-Ou Liu

,

Shuo Wang

,

Yuan-Li Zhao

Originally published21 Sep 2020https://doi.org/10.1161/STROKEAHA.120.029942Stroke. ;0

Abstract

Background and Purpose:

Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management.

Methods:

We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020.

Results:

The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5–3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95%CI, 1.86–9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95%CI, 1.82–3.63]), brainstem location (adjusted odds ratio, 2.93 [95%CI, 1.28–6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95%CI, 1.01–4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77–0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78–0.96]).

Conclusions:

Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients.(Useless, don't you think patients might want solutions to prevent that risk?)

REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT04076449.