Acute Subdural Hematomas in Ruptured Brain Arteriovenous Malformations: Association with Distal Flow-Related Aneurysms

  • Eimad ShotarEmail author
  • Nader-Antoine Sourour
  • Kevin Premat
  • Idriss Haffaf
  • Sam Ghazanfari
  • Alice Jacquens
  • Aurélien Nouet
  • Stéphanie Lenck
  • Jacques Chiras
  • Vincent Degos
  • Frédéric Clarençon
Original Article



Non-traumatic acute subdural hematomas (SDH) are rare and have seldom been reported in ruptured brain arteriovenous malformations (BAVM). The aim of this study was to report the frequency of acute SDH in BAVM-related hemorrhage and to determine the relationship of SDHs with BAVM angioarchitectural features.


This was a retrospective monocentric study of patients admitted for BAVM rupture between 2003 and 2017. Patients with rupture complicating or closely following partial embolization procedures were excluded. Univariate followed by multivariate logistic regression analysis was used to determine factors significantly and independently associated with SDHs and distal flow-related aneurysms.


A total of 181 patients with 188 BAVM ruptures admitted during the study period were included, eleven cases of acute SDH were identified (6%) and 2 cases of isolated SDH were found. The presence of a distal flow-related aneurysm was the only feature independently and significantly associated with SDH (odds ratio [OR] 8.1, 95% confidence interval, CI 1.9–34.5, P = 0.003). Distal flow-related aneurysms were associated with proximal flow-related aneurysms (OR 28, 95%CI 4.9–163.8, P < 0.001), were more frequent in infratentorial BAVMs (OR 3.7, 95%CI 1.3–10.2, P = 0.01) and more often found in cases of acute SDH (OR 16.9, 95%CI 3.6–79.6, P < 0.001) and subarachnoid hemorrhage (SAH) (OR 4.5, 95%CI 1.7–12.2, P = 0.003).


Ruptured BAVMs can rarely present with acute SDH and SDH in ruptured BAVMs are often associated with distal flow-related aneurysms. This finding may impact acute management of ruptured BAVMs with SDH by eliciting an emergent and thorough imaging work-up to identify distal flow-related aneurysm(s), in turn leading to treatment.


Arteriovenous malformation Aneurysm Hemorrhage Stroke Subdural 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

E. Shotar, N.-A. Sourour, K. Premat, I. Haffaf, S. Ghazanfari, A. Jacquens, A. Nouet, S. Lenck, J. Chiras, V. Degos and F. Clarençon declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Eimad Shotar
    • 1
    Email author
  • Nader-Antoine Sourour
    • 1
  • Kevin Premat
    • 1
    • 2
  • Idriss Haffaf
    • 1
  • Sam Ghazanfari
    • 1
  • Alice Jacquens
    • 3
  • Aurélien Nouet
    • 4
  • Stéphanie Lenck
    • 1
  • Jacques Chiras
    • 1
    • 2
  • Vincent Degos
    • 2
    • 3
  • Frédéric Clarençon
    • 1
    • 2
  1. 1.Department of NeuroradiologyPitié-Salpêtrière HospitalParisFrance
  2. 2.Sorbonne UniversitéParisFrance
  3. 3.Department of Neurosurgical Anesthesiology and Critical CarePitié-Salpêtrière HospitalParisFrance
  4. 4.Department of NeurosurgeryPitié-Salpêtrière HospitalParisFrance

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