Cavernous Malformation Hemorrhagic Presentation at Diagnosis Associated with Low 25-Hydroxy-Vitamin D Level

Autor: Shivram Kumar, Giuseppe Lanzino, Ravinder J. Singh, Kelly D. Flemming, Lauren McCreath, Kevin J. Whitehead, Robert D. Brown
Rok vydání: 2020
Předmět:
Adult
Male
Hemangioma
Cavernous
Central Nervous System
medicine.medical_specialty
Adolescent
030204 cardiovascular system & hematology
Risk Assessment
Gastroenterology
Central Nervous System Neoplasms
Angioma
Young Adult
03 medical and health sciences
0302 clinical medicine
Risk Factors
Seizures
Internal medicine
medicine
Vitamin D and neurology
Humans
Prospective Studies
Registries
Vitamin D
Child
Aged
medicine.diagnostic_test
business.industry
Medical record
Magnetic resonance imaging
Middle Aged
Prognosis
Vitamin D Deficiency
medicine.disease
Cavernous malformations
Magnetic Resonance Imaging
Occult
Neurology
Female
Neurology (clinical)
Presentation (obstetrics)
Cardiology and Cardiovascular Medicine
business
Intracranial Hemorrhages
Body mass index
Biomarkers
030217 neurology & neurosurgery
Zdroj: Cerebrovascular Diseases. 49:216-222
ISSN: 1421-9786
1015-9770
DOI: 10.1159/000507789
Popis: Background: Cavernous malformations (CM) are angiographically occult vascular malformations that may be incidental or present with intracerebral or spinal hemorrhage, seizures, or nonhemorrhagic focal neurologic deficit (FND). Recently in vitro data have suggested vitamin D may play a role in stabilizing CCM2 endothelial cells. Little is known about the effect of vitamin D in human CM disease. Methods: Beginning in 2015, consecutive patients at our institution with radiologically confirmed CM were recruited to participate in a prospective clinical registry as well as 25-hydroxy-vitamin D study. A structured interview, survey, and examination were performed at baseline. Medical records and magnetic resonance imaging studies were reviewed and data collected included comorbid conditions, medication use, and location of CM. Standard definition of clinical hemorrhage, FND, and seizures was used. Univariate and multivariate logistic regression models were used, and OR, 95% CIs, and likelihood-ratio p values were calculated to determine the influence of the 25-hydroxy-vitamin D level on clinical presentation with hemorrhage. Results: Of 213 patients enrolled in the clinical registry between January 2015 and October 2018, 70 participated in the vitamin D study (median age: 38.3 years; 51.4% female). Of the 70 participants, 30 (42.9%) presented with hemorrhage. 25-Hydroxy-vitamin D levels were performed within 1 year of symptoms in 64.1% of patients. Patients presenting with hemorrhage had a lower 25-hydroxy-vitamin D level compared to those presenting with seizure without hemorrhage, FND, or as an incidental finding (median 25.5 ng/mL; range 11–59 hemorrhage vs. median 31.0; range 14–60, no hemorrhage; p = 0.04). After adjusting for age, month of blood draw, and body mass index, 25-hydroxy-vitamin D remained a significant predictor of hemorrhagic presentation. Brainstem location also predicted hemorrhage at presentation. Conclusion: Low 25-hydroxy-vitamin D level was more common in patients with CM presenting with hemorrhage. This study supports the potential role of modifiable factor in the initial clinical presentation of CM. Further study is needed to determine the role of vitamin D on prospective hemorrhage risk and whether supplementation may be beneficial.
Databáze: OpenAIRE
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