Tag: Symptoms

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Clinical and radiological presentation of cavernomas according to the Zabramski classification

J Neurosurg 142:1751–1762, 2025

Most cerebral cavernous malformations (CCMs) are asymptomatic, especially Zabramski type IV. Symptoms, mainly seizures or neurological deficits, are primarily linked to Zabramski type I. Type I CCMs often regress to types II/III, but up to one-quarter develop new symptoms over time.

• Most cerebral cavernous malformations (CCMs) are asymptomatic and found incidentally on MRI.

• Zabramski classification is widely used to describe CCMs’ radiological features, but its correlation with clinical symptoms was not well established before this study.

• Zabramski type I CCMs are mostly symptomatic and associated with an unstable clinical course; types II and III are usually asymptomatic or have mild symptoms; type IV CCMs are always asymptomatic.

• Epileptic seizures are the most common presenting symptom, especially for supratentorial CCMs; infratentorial CCMs more often cause balance problems and cranial nerve deficits.

• Most Zabramski type I CCMs regress over time to type II or III; very few type II or III CCMs change to type I.

• Age is associated with Zabramski type: type I CCMs occur in younger patients, type III in older.

• Nearly all Zabramski type IV CCMs appear in patients with multiple CCMs and remain stable and asymptomatic over time.

• The Zabramski type at diagnosis can help predict the future clinical course of CCMs.

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Predictors of Poor Quality of Life 1 Year After Subarachnoid Hemorrhage

A Simple and Quantitative Method to Predict Symptomatic Vasospasm After Subarachnoid Hemorrhage Based on Computed Tomography- Beyond the Fisher Scale

Neurosurgery 78:256–264, 2016

Risk factors for poor quality of life (QOL) after subarachnoid hemorrhage (SAH) remain poorly described.

OBJECTIVE: To identify the frequency and predictors of poor QOL 1 year after SAH.

METHODS: We studied 1-year QOL in a prospectively collected cohort of 1181 consecutively admitted SAH survivors between July 1996 and May 2013. Patient clinical, radiographic, surgical, and acute clinical course information was recorded. Reduced QOL (overall, physical, and psychosocial) at 1 year was assessed with the Sickness Impact Profile and defined as 2 SD below population-based normative Sickness Impact Profile values. Logistic regression leveraging multiple imputation to handle missing data was used to evaluate reduced QOL.

RESULTS: Poor overall QOL was observed in 35% of patients. Multivariable analysis revealed that nonwhite ethnicity, high school education or less, history of depression, poor clinical grade (Hunt-Hess Grade $3), and delayed infarction were predictors of poor overall and psychosocial QOL. Poor physical QOL was additionally associated with older age, hydrocephalus, pneumonia, and sepsis. At 1 year, patients with poor QOL had increased difficulty concentrating, cognitive dysfunction, depression, and reduced activities of daily living. More than 91% of patients with poor QOL failed to fully return to work. These patients frequently received physical rehabilitation, but few received cognitive rehabilitation or emotional-behavioral support.

CONCLUSION: Reduced QOL affects as many as one-third of SAH survivors 1 year after SAH. Delayed infarction is the most important in-hospital modifiable factor that affects QOL. Increased attention to cognitive and emotional difficulties after hospital discharge may help patients achieve greater QOL.

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