Demographic Data |
Relation to Proband |
child |
Age at Sampling |
12 YR |
Gender |
Male |
Age of Onset(If not a control) |
12 YR |
Age at Diagnosis(If not a control) |
12 YR |
Hispanic or Latino/Not Hispanic or Latino |
Hispanic/Latino |
Racial Category |
More than one race |
Country |
USA |
Diagnosed By |
No Data |
|
Data Elements |
Clinical Element Type: Cerebrovascular Disease |
(Baseline) |
Longitudinal Data |
Is this data Longitudinal (Follow-Up) Data? |
yes no |
Smoking History |
smoking history |
never former smoker current smoker |
years smoking |
No Data |
Family History |
Family history of Cerebrovascular Disease |
present absent Unknown Notes: CCM (MOTHER, GRANDMOTHER, GREAT GRANDMOTHER, UNCLE, FIRST COUSIN, 2 GREAT AUNTS, 1 GREAT UNCLE, 4 FIRST COUSINS ONCE REMOVED) |
Family History of Aneurysm |
present absent Unknown Notes: GREAT GRANDMOTHER, GREAT AUNT, GREAT UNCLE |
Specific diagnosis |
Cerebrovascular diagnosis |
silent cerebral infarction transient ischemic attack unruptured intracranial aneurysm symptomatic ischemic stroke symptomatic intracerebral hemorrhage aneurysmal subarachnoid hemorrhage vascular cognitive impairment arteriovenous malformations (AVM) other Unaffected primary blood relative of proband Cerebral Cavernous Malformation (CCM) Hereditary Hemorrhagic Telangiectasia (HHT)
|
Prior Medical History |
Pre-existing history of dementia |
Present Absent |
Pre-hemorrhage history of ischemic stroke |
Present Absent Not Applicable |
TOAST criteria |
ischemic stroke subtype based on TOAST |
not applicable |
AVM subtype criteria |
AVM type |
unruptured ruptured not applicable |
Spetzler-Martin score |
No Data |
Size |
No Data |
AVM Location |
No Data |
Venous drainage |
No Data |
Drainage Location |
cortical subcortical/deep posterior fossa
|
Confirmation of diagnosis |
did a neurologist confirm the cerebrovascular diagnosis |
yes no |
Medical History |
hypertension |
yes no |
diabetes mellitus |
yes no |
atrial fibrillation |
yes no |
myocardial infarction |
yes no |
Other risk factors |
yes no |
Genetic Data of Subject |
Mutation/s in subject's DNA (if present, describe) |
present absent unknown Notes: CCM1-CHM |
Medical History |
Hypertension treated with medication |
yes no |
Blood pressure (at time of blood draw) |
114/71 |
Other diagnosis |
Parkinson's disease |
yes no |
Alzheimer's disease |
yes no |
Epilepsy |
yes no |
Amyotrophic lateral sclerosis |
yes no |
Dementia |
yes no |
Optional data |
State Examination (MMSE) score |
No Data |
Neurological examination |
yes no |
Handedness |
Right Left Ambidextrous |
Clinical Element Type: Cerebral Cavernous Malformation (CCM) |
(Baseline) |
Family History |
Family History of CCM: |
Present Absent Unknown |
If present, list family members: |
MOTHER, GRANDMOTHER, GREAT GRANDMOTHER, UNCLE, FIRST COUSIN, 4 FIRST COUSINS ONCE REMOVED, 2 GREAT AUNTS, 1 GREAT UNCLE |
Known Genetic Syndrome: |
Present Absent Unknown |
Please Specify, if applicable: |
No Data |
Known Mutation(s) in DNA: |
Present Absent Unknown |
Please specify, if applicable: |
CCM1-CHM |
Diagnostic Criteria |
Number of CCM lesions on MRI: |
Single Multiple |
Age at MRI: |
12 YEARS |
Presentation at symptom onset: |
Seizure Headache Clinical Stroke Asymptomatic
|
Modified Rankin Score: |
0 1 2 3 4 5 6 |
Optional Data |
Smoking History: |
Never Previous Current |
Years Smoking, if applicable: |
No Data |
Handedness: |
Left Right Ambidextrous |