Natural History of Cerebral Angiomas

Abstract

The natural history of angioma haemorrhage seems to be related to the size of the angioma. Haemorrhages from the common medium-size angiomas are usually mild and may recur at long intervals over many years. Small angiomas, on the other hand, are apt to bleed in children and rapidly produce a dangerous intracerebral haematoma in the first attack, whereas fatal haemorrhages from large (inoperable) angiomas often do not occur until later life, sometimes after fits or progressive cerebral disability for many years. Forty-nine (84%) of the 58 patients who had haemorrhage were alive five years after the first bleeding; only two patients died from the effects of a safely removable angioma (with haematoma). These results probably justify a conservative surgical policy, but it is nevertheless believed that more angiomas should have been removed to prevent fatal haemorrhages that will no doubt occur in future years. Svien and McRae (1965) found that only 16% of 68 unoperated patients (out of a total of 95) seen at the Mayo clinic during 1920-61 had died from the angioma. We agree with their conclusion that, in retrospect, conservative treatment is appropriate for 80 to 85 % of patients, but when patients are first seen the possibility of fatal recurrent haemorrhage is unpredictable, and some deaths will be prevented by excising the considerable number of angiomas that are removable without risk of producing serious neurological damage. It is, however, by the prompt evacuation of intracerebral haematoma that many avoidable deaths can be prevented. It is emphasized that angiography should be used with restraint, especially in patients with large angiomas (and in the investigation of all subarachnoid haemorrhages), to avoid producing increased disability or fatality. © 1967, British Medical Journal Publishing Group. All rights reserved.