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Findlay MC, Kim RB, Putnam AR, Couldwell WT. Management of Symptomatic Hemorrhage From a Developmental Venous Anomaly. Cureus 2024; 16:e58130. [PMID: 38738135 PMCID: PMC11088928 DOI: 10.7759/cureus.58130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/14/2024] Open
Abstract
Developmental venous anomalies (DVAs) are clinically benign, low-flow vascular malformations that classically hemorrhage only when associated with a cerebral cavernous malformation. It is very rare for an isolated DVA to hemorrhage. Resection of the DVA is generally contraindicated because of the high risk of venous infarct. We present the case of a large symptomatic hemorrhage stemming from an isolated DVA. The hematoma was evacuated and the hemorrhagic portion of the DVA was resected. This case demonstrates that in rare circumstances, careful resection can successfully treat hemorrhagic DVAs.
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Affiliation(s)
| | - Robert B Kim
- Department of Neurosurgery, University of Utah, Salt Lake City, USA
| | | | - William T Couldwell
- Department of Neurosurgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, USA
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2
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Subarachnoid hemorrhage due to developmental venous anomaly: A case report. BRAIN HEMORRHAGES 2021. [DOI: 10.1016/j.hest.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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3
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Sabayan B, Lineback C, Viswanathan A, Leslie‐Mazwi TM, Shaibani A. Central nervous system vascular malformations: A clinical review. Ann Clin Transl Neurol 2021; 8:504-522. [PMID: 33434339 PMCID: PMC7886037 DOI: 10.1002/acn3.51277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022] Open
Abstract
CNS vascular malformation is an umbrella term that encompasses a wide variety of pathologies, with a wide range of therapeutic and diagnostic importance. This range spans lesions with a risk of devastating neurological compromise to lesions with a slow, static or benign course. Advances in neurovascular imaging along with increased utilization of these advances, have resulted in more frequent identification of these lesions. In this article, we provide an overview on definitions and classifications of CNS vascular malformations and outline the etiologic, diagnostic, prognostic, and therapeutic features for each entity. This review covers intracranial and spinal cord vascular malformations and discusses syndromes associated with CNS vascular malformations.
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Affiliation(s)
- Behnam Sabayan
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Christina Lineback
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Anand Viswanathan
- Department of NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Thabele M. Leslie‐Mazwi
- Departments of Neurosurgery and NeurologyMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ali Shaibani
- Department of RadiologyNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Aghayev K. Surgically Treated Epilepsy due to Developmental Venous Anomaly of the Brain: Case Report and Review of the Literature. World Neurosurg 2020; 141:119-122. [PMID: 32540289 DOI: 10.1016/j.wneu.2020.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND A congenital malformation of the brain vessels, developmental venous anomaly (DVA) is considered a benign lesion, requiring no intervention unless symptomatic. Epilepsy is a well-known clinical manifestation of DVA. Successful surgery for DVA-associated epilepsy with has been sporadically reported in the literature; however, in all published cases, the anomaly was left intact along with the accompanying lesion. Here we present a surgical case of DVA located in the vicinity of the motor cortex causing drug-resistant simple partial epilepsy. CASE DESCRIPTION A 34-year-old man was referred due to medically intractable simple partial seizures. He was found to have DVA anterior to the motor cortex that was surgically removed. Following the surgical resection, the patient's seizures stopped, and there were no long-term complications of the procedure. CONCLUSIONS DVA removal can be performed in selected cases, but more studies are needed to assess the complication rate.
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Affiliation(s)
- Kamran Aghayev
- Department of Neurosurgery, Biruni University, Istanbul, Turkey.
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Abdelgawad MS, Aly RA. Value of susceptibility-weighted MR imaging (SWI) in the detection of developmental venous anomaly. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00216-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Background
Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. Susceptibility-weighted imaging (SWI) is a high spatial resolution 3D gradient-echo MRI sequence with phase post-processing that accentuates the paramagnetic properties of blood products such as deoxyhemoglobin, intracellular methemoglobin, and hemosiderin. Its high sensitivity to hemorrhagic particles by means of susceptibility dephasing effects within the veins allow for the accurate detection, grading, and monitoring of brain venous anomalies. In this review, we evaluated the prevalence of the brain DVAs identified by SWI in many patients who had undergone magnetic resonance imaging (MRI) with contrast administration. All images were independently reviewed by two radiologists who were blinded to other MR imaging finding. It is hoped that as SWI becomes more widely available, it will provide additional diagnostic and prognostic information that will improve the care and outcome of patients with DVAs.
Results
A total of 29 DVAs were observed with its prevalence 2.8%. The DVA caputs had mostly deep localization in about 44.8% of our DVA cases. SWI proved excellent demonstration of DVAs with the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were significantly higher than the other non-contrast MR sequences. On SWI, DVA is delineated as a signal void lesion with the normal cerebral veins.
Conclusion
Susceptibility-weighted imaging (SWI) is valuable in the diagnosis of DVA and should be included in routine MR assessment of the brain.
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Nakase K, Motoyama Y, Nakai T, Takeshima Y, Nakagawa I, Park YS, Ohbayashi C, Nakase H. Cavernous Malformation Associated With Arterialized Developmental Venous Anomaly: A Case Report. Neurosurgery 2017; 80:E257-E262. [DOI: 10.1093/neuros/nyx065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 03/26/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE: Formation of cavernous malformations (CMs) has been recognized to be associated with developmental venous anomaly (DVA) by many authors. Hemodynamic stress due to venous outflow restriction could be hypothesized as a cause. On the other hand, a rare subgroup of DVA with an arterial component has been reported as likely to hemorrhage or be symptomatic. Cases of arterialized DVAs reported previously have not been associated with the presence of CM.
CLINICAL PRESENTATION: We present herein a case report of arterialized DVA in the brainstem with repeated cerebellar hemorrhage. The 49-year-old patient was treated with surgical evacuation of hematoma. A surgical specimen from the hematoma cavity demonstrated CMs on histological examination.
CONCLUSION: To the best of our knowledge, this represents the first report of CM associated with an arterialized DVA. In addition to venous congestion due to outflow obstruction, bleeding from the arterial component of the DVA might be considered as a cause of CM formation.
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Affiliation(s)
- Kenta Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tokiko Nakai
- Pathology, Nara Medical Unive-rsity, Kashihara, Nara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | - Young-Su Park
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan
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Amuluru K, Al-Mufti F, Hannaford S, Singh IP, Prestigiacomo CJ, Gandhi CD. Symptomatic Infratentorial Thrombosed Developmental Venous Anomaly: Case Report and Review of the Literature. INTERVENTIONAL NEUROLOGY 2016; 4:130-7. [PMID: 27051409 DOI: 10.1159/000444028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Developmental venous anomalies (DVAs) are variations of normal transmedullary veins draining white and gray matter. In the vast majority of cases, DVAs are diagnosed incidentally and should be considered as benign entities. In extremely rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. Thrombosis of the collector vein of a DVA is a rare type of a flow-related complication with only 29 cases reported in the literature, the majority of which are supratentorial. Infratentorial thrombosed DVAs are thus extremely rare and the few cases reported have typically caused symptoms due to venous ischemic infarctions. SUMMARY We report a case of an infratentorial DVA with a thrombosed drainage vein in a patient with nonhemorrhagic, noninfarcted venous congestive edema, which was successfully treated with high-dose glucocorticoids and short-term anticoagulation. We review the pertinent venous anatomy of the posterior fossa as well as the literature of symptomatic infratentorial thrombosed DVAs. KEY MESSAGE The presented case of an infratentorial thrombosed DVA with cerebellar and pontine venous congestive edema is extremely rare. A working knowledge of posterior fossa venous anatomy and possible pathomechanisms responsible for the rarely symptomatic lesion will aid in the timely and efficacious treatment of such lesions.
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Affiliation(s)
- Krishna Amuluru
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA
| | - Fawaz Al-Mufti
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA
| | - Stephen Hannaford
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA
| | - Inder Paul Singh
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Neurology, Rutgers University School of Medicine, Newark, N.J., USA
| | - Charles J Prestigiacomo
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Neurology, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Radiology, Rutgers University School of Medicine, Newark, N.J., USA
| | - Chirag D Gandhi
- Departments of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Neurology, Rutgers University School of Medicine, Newark, N.J., USA; Departments of Radiology, Rutgers University School of Medicine, Newark, N.J., USA
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Intracerebral Hemorrhage due to Venous Thrombosis of Developmental Venous Anomaly during Pregnancy. J Stroke Cerebrovasc Dis 2015; 24:e185-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 02/10/2015] [Accepted: 03/18/2015] [Indexed: 11/23/2022] Open
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Pilato F, Calandrelli R, Gaudino S, Profice P, Martucci M, Esposito G, Colosimo C, Di Lazzaro V. Thrombosis of a developmental venous anomaly in inflammatory bowel disease: case report and radiologic follow-up. J Stroke Cerebrovasc Dis 2013; 22:e250-3. [PMID: 23287422 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/02/2012] [Accepted: 11/28/2012] [Indexed: 01/06/2023] Open
Abstract
Developmental venous anomalies (DVAs) are benign embryologic vascular variants, and before the advent of computed tomography and magnetic resonance imaging were supposed to be rare conditions. Usually, DVAs are asymptomatic and accidentally discovered during routine brain imaging studies, but sometimes they can be the cause of disabling neurologic symptoms. We describe the clinical and neuroradiologic follow-up of a 62-year-old man with a history of inflammatory bowel disease (IBD) presenting with new onset epilepsy and intracranial hemorrhage caused by thrombosis of a DVA who fully recovered after treatment with oral anticoagulant therapy. Patients with IBD have an increased risk of thrombosis because of inflammatory activity and the hypercoagulable state. Here we describe the first case of DVA thrombosis in a patient with IBD, and we show clinical and neuroradiologic follow-up after anticoagulant therapy.
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Affiliation(s)
- Fabio Pilato
- Institute of Neurology, Università Cattolica, Rome, Italy.
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10
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Biopsy neuropathology of cerebral ischemia associated with a developmental venous anomaly. Clin Neurol Neurosurg 2012; 115:621-3. [PMID: 22771305 DOI: 10.1016/j.clineuro.2012.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/14/2012] [Accepted: 06/15/2012] [Indexed: 11/20/2022]
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Kathuria S, Chen J, Gregg L, Parmar HA, Gandhi D. Congenital Arterial and Venous Anomalies of the Brain and Skull Base. Neuroimaging Clin N Am 2011; 21:545-62, vii. [DOI: 10.1016/j.nic.2011.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pearl M, Gregg L, Gandhi D. Cerebral Venous Development in Relation to Developmental Venous Anomalies and Vein of Galen Aneurysmal Malformations. Semin Ultrasound CT MR 2011; 32:252-63. [DOI: 10.1053/j.sult.2011.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kiroglu Y, Oran I, Dalbasti T, Karabulut N, Calli C. Thrombosis of a Drainage Vein in Developmental Venous Anomaly (DVA) Leading Venous Infarction: A Case Report and Review of the Literature. J Neuroimaging 2011; 21:197-201. [PMID: 19555403 DOI: 10.1111/j.1552-6569.2009.00399.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yilmaz Kiroglu
- Department of Radiology, Pamukkale University, Denizli, Turkey.
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15
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Abstract
INTRODUCTION Cerebral developmental venous anomalies (DVAs) are the most frequently encountered cerebral vascular malformation. As such, they are often observed incidentally during routine CT and MRI studies. Yet, what DVAs represent from a clinical perspective is frequently not common knowledge and DVAs, therefore, still generate uncertainty and concern amongst physicians. This article reviews our current understanding of developmental venous anomalies. RESULTS In the majority of cases, DVAs follow a benign clinical course. On rare occasions, DVAs become symptomatic generally due to an underlying associated vascular malformation such as cavernous malformations or thrombosis of the collecting vein. Rare forms of DVAs include arterialized DVAs and DVAs involved in the drainage of sinus pericranii, which warrant additional investigation by digital subtraction angiography. Cerebral abnormalities such as atrophy, white matter lesions and calcifications within the drainage territory of asymptomatic DVAs, are often identified on CT or MR imaging studies and likely represent secondary changes due to venous hypertension. There is increasing evidence that DVAs have a propensity for developing venous hypertension, which is thought to be the cause of associated cavernous malformations and parenchymal abnormalities. CONCLUSIONS DVAs represent variations of the normal cerebral venous angioarchitecture and by enlargement follow an uneventful clinical course. Complications can, however, occur and their management requires a thorough understanding of the nature of DVAs, including their frequent coexistence with other types of vascular malformation, and the existence of more complex but rare forms of presentation, such as the arterialized DVAs.
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Rubin D, Santillan A, Greenfield JP, Souweidane M, Riina HA. Surgical management of pediatric cerebral arteriovenous malformations. Childs Nerv Syst 2010; 26:1337-44. [PMID: 20596869 DOI: 10.1007/s00381-010-1211-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/12/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arteriovenous malformations (AVMs) are the most common cause of intracerebral hemorrhage in children. Different options exist for their successful management consisting of surgery, endovascular embolization, stereotactic radiosurgery, or a combination of these treatments. DISCUSSION In this paper, we discuss the different treatment modalities in the treatment of pediatric cerebral AVMs emphasizing the role of surgery and endovascular embolization as a preoperative strategy.
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Affiliation(s)
- David Rubin
- Department of Neurological Surgery,Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA
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17
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Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion. Neuroradiology 2010; 53:331-41. [PMID: 20652805 PMCID: PMC3077751 DOI: 10.1007/s00234-010-0739-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 06/23/2010] [Indexed: 12/02/2022]
Abstract
Introduction Developmental venous anomalies (DVA) consist of dilated intramedullary veins that converge into a large collecting vein. The appearance of these anomalies was evaluated on whole-brain computed tomography (CT) digital subtraction angiography (DSA) and CT perfusion (CTP) studies. Methods CT data sets of ten anonymized patients were retrospectively analyzed. Five patients had evidence of DVA and five age- and sex-matched controls were without known neurovascular abnormalities. CT angiograms, CT arterial-venous views, 4-D CT DSA and CTP maps were acquired on a dynamic volume imaging protocol on a 320-detector row CT scanner. Whole-brain CTP parameters were evaluated for cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), mean transit time (MTT), and delay. DSA was utilized to visualize DVA anatomy. Radiation dose was recorded from the scanner console. Results Increased CTP values were present in the DVA relative to the unaffected contralateral hemisphere of 48%, 32%, and 26%; and for the control group with matched hemispheric comparisons of 2%, −10%, and 9% for CBF, CBV, and MTT, respectively. Average effective radiation dose was 4.4 mSv. Conclusion Whole-brain DSA and CTP imaging can demonstrate a characteristic appearance of altered DVA hemodynamic parameters and capture the anomalies in superior cortices of the cerebrum and the cerebellum. Future research may identify the rare subsets of patients at increased risk of adverse outcomes secondary to the altered hemodynamics to facilitate tailored imaging surveillance and application of appropriate preventive therapeutic measures.
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Hong YJ, Chung TS, Suh SH, Park CH, Tomar G, Seo KD, Kim KS, Park IK. The angioarchitectural factors of the cerebral developmental venous anomaly; can they be the causes of concurrent sporadic cavernous malformation? Neuroradiology 2010; 52:883-91. [PMID: 20091405 DOI: 10.1007/s00234-009-0640-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 11/18/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Yoo Jin Hong
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eunjuro, Gangnam-gu, Seoul, South Korea, 135-270
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Ruíz DSM, Yilmaz H, Gailloud P. Cerebral developmental venous anomalies: Current concepts. Ann Neurol 2009; 66:271-83. [PMID: 19798638 DOI: 10.1002/ana.21754] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Diego San Millán Ruíz
- Division of Interventional and Diagnostic Neuroradiology, Geneva University Hospital, Geneva, Switzerland.
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Abstract
ABSTRACT
DEVELOPMENTAL VENOUS ANOMALIES (DVAs), formerly known as venous angiomas, have become the most frequently diagnosed intracranial vascular malformation. DVAs are currently considered congenital cerebrovascular anomalies with mature venous walls that lack arterial or capillary elements. They are composed of radially arranged medullary veins, which converge in an enlarged transcortical or subependymal collector vein, and have characteristic appearances (caput medusae) on magnetic resonance imaging and angiography. DVAs were once thought to be rare lesions with substantial potential for intracerebral hemorrhage and considerable morbidity. The prevalence of incidental and asymptomatic DVAs has been more apparent since the advent of magnetic resonance imaging; recent cohort studies have challenged the once-held view of isolated DVAs as the cause of major neurological complications. The previously reported high incidence of intracerebral hemorrhage associated with DVAs is currently attributed to coexistent, angiographically occult cavernous malformations. Some patients may still have noteworthy neurological morbidity or die as a result of acute infarction or hemorrhage directly attributed to DVA thrombosis. DVAs can coexist with cavernous malformations and arteriovenous malformations. Such combination or transitional forms of malformations might suggest common pathways in pathogenesis. Recent data support a key role for DVAs in the pathogenesis of mixed vascular malformations.
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Affiliation(s)
- Stylianos K Rammos
- Department of Neurosurgery, Illinois Neurological Institute, University of Illinois at Peoria, Peoria, Illinois, USA
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Abarca-Olivas J, Botella-Asunción C, Concepción-Aramendía L, Cortés-Vela J, Gallego-León J, Ballenilla-Marco F. Hemorragia intracerebral secundaria a trombosis espontánea de una anomalía venosa del desarrollo: 2 casos y revisión de la literatura. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70166-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pereira VM, Geibprasert S, Krings T, Aurboonyawat T, Ozanne A, Toulgoat F, Pongpech S, Lasjaunias PL. Pathomechanisms of Symptomatic Developmental Venous Anomalies. Stroke 2008; 39:3201-15. [PMID: 18988912 DOI: 10.1161/strokeaha.108.521799] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background and Purpose—
Although it is generally accepted that developmental venous anomalies (DVAs) are benign vascular malformations, over the past years, we have seen patients with symptomatic DVAs. Therefore, we performed a retrospective study and a literature study to review how, when, and why DVAs can become clinically significant.
Methods—
Charts and angiographic films of 17 patients with DVAs whose 18 vascular symptoms could be attributed to a DVA were selected from a neurovascular databank of our hospital. MRI had to be available to rule out any other associated disease. In the literature, 51 cases of well-documented symptomatic DVAs were found. Pathomechanisms were divided into mechanical and flow-related causes.
Results—
Mechanical (obstructive or compressive) pathomechanisms accounted for 14 of 69 symptomatic patients resulting in hydrocephalus or nerve compression syndromes. Flow-related pathomechanisms (49 of 69 patients) could be subdivided into complications resulting from an increase of flow into the DVA (owing to an arteriovenous shunt using the DVA as the drainage route; n=19) or a decrease of outflow (n=26) or a remote shunt with increased venous pressure (n=4) leading to symptoms of venous congestion. In 6 cases, no specific pathomechanisms were detected.
Conclusions—
Although DVAs should be considered benign, under rare circumstances, they can be symptomatic. DVAs, as extreme variations of normal venous drainage, may represent a more fragile venous drainage system that can be more easily affected by in- and outflow alterations. The integrity of the DVA needs to be preserved irrespective of the treatment that should be tailored to the specific pathomechanism.
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Affiliation(s)
- Vitor M. Pereira
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Sasikhan Geibprasert
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Timo Krings
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Thaweesak Aurboonyawat
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Augustin Ozanne
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Frederique Toulgoat
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Sirintara Pongpech
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
| | - Pierre L. Lasjaunias
- From the Service de Neuroradiologie Diagnostique et Thérapeutique (V.M.P., S.G., T.K., T.A., A.O., F.T., P.L.L.), Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; the Department of Radiology (S.G., S.P.), Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and the Department of Neuroradiology (T.K.), University Hospital Aachen, Aachen, Germany; and the Division of Neuroradiology, Department of Medical Imaging (T.K.), Toronto Western Hospital, Toronto, Canada
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23
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Amemiya S, Aoki S, Takao H. Venous congestion associated with developmental venous anomaly: Findings on susceptibility weighted imaging. J Magn Reson Imaging 2008; 28:1506-9. [PMID: 19025939 DOI: 10.1002/jmri.21546] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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24
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Walsh M, Parmar H, Mukherji SK, Mamourian A. Developmental venous anomaly with symptomatic thrombosis of the draining vein. J Neurosurg 2008; 109:1119-22. [PMID: 19035729 DOI: 10.3171/jns.2008.109.12.1119] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Developmental venous anomalies (DVAs) are generally considered a benign and asymptomatic finding on CT and MR imaging. The authors report 2 cases of spontaneous thrombosis of the draining vein of a DVA depicted on CT and MR imaging. One patient presented with a nonhemorrhagic transient ischemia, which was successfully treated with anticoagulant therapy. The second patient presented with ischemia complicated by hemorrhagic conversion.
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Affiliation(s)
- Michael Walsh
- 1Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; and
| | - Hemant Parmar
- 1Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; and
| | - Suresh K. Mukherji
- 1Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; and
| | - Alexander Mamourian
- 2Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Santucci GM, Leach JL, Ying J, Leach SD, Tomsick TA. Brain parenchymal signal abnormalities associated with developmental venous anomalies: detailed MR imaging assessment. AJNR Am J Neuroradiol 2008; 29:1317-23. [PMID: 18417603 DOI: 10.3174/ajnr.a1090] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The occurrence of brain parenchymal signal-intensity changes within the drainage territory of developmental venous anomalies (DVAs) in the absence of cavernous malformations (CMs) has been incompletely assessed. This study was performed to evaluate the prevalence of brain parenchymal signal-intensity abnormalities subjacent to DVA, correlating with DVA morphology and location. MATERIALS AND METHODS One hundred sixty-four patients with brain MR imaging with contrast studies performed from July 2005 through June 2006 formed the study group. The examinations were reviewed and data were collected regarding the following: location, depth, size of draining vein, associated increased signal intensity on fluid-attenuated inversion recovery and T2-weighted images, associated CMs, and associated signal intensity on gradient recalled-echo sequences. RESULTS Of the 175 DVAs identified, 28 had associated signal-intensity abnormalities in the drainage territory. Seven of 28 DVAs with signal-intensity abnormalities were excluded because of significant adjacent white matter signal-intensity changes related to other pathology overlapping the drainage territory. Of the remaining DVAs imaged in this study, 21/168 (12.5%) had subjacent signal-intensity abnormalities. An adjusted prevalence rate of 9/115 (7.8%) was obtained by excluding patients with white matter disease more than minimal in degree. Periventricular location and older age were associated with DVA signal-intensity abnormality. CONCLUSION Signal-intensity abnormalities detectable by standard clinical MR images were identified in association with 12.5% of consecutively identified DVAs. Excluding patients with significant underlying white matter disease, we adjusted the prevalence to 7.8%. The etiology of the signal-intensity changes is unclear but may be related to edema, gliosis, or leukoaraiosis secondary to altered hemodynamics in the drainage area.
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Affiliation(s)
- G M Santucci
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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26
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Brasse G, Stammel O, Siemens P, Töpper R. Thrombose eines venösen Angioms mit sekundärem Stauungsinfarkt. DER NERVENARZT 2008; 79:703-5. [PMID: 18389202 DOI: 10.1007/s00115-008-2457-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- G Brasse
- Max-Planck-Institut für Kognitions- und Neurowissenschaften, Stephanstrasse 1A, Leipzig, Germany.
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27
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Zimmer A, Hagen T, Ahlhelm F, Viera J, Reith W, Schulte-Altedorneburg G. [Developmental venous anomaly (DVA)]. Radiologe 2008; 47:868, 870-4. [PMID: 17624510 DOI: 10.1007/s00117-007-1528-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As congenital anatomic variants of venous drainage, developmental venous anomalies (DVA) represent up to 60% of all cerebral vascular malformations. The prior term "venous angioma" is a misnomer implicating an abnormal vascular structure with an increased bleeding risk. They are often found incidentally and are hardly ever symptomatic. Their morphologic characteristics are dilated vessels in the white matter, which converge on a greater collector vein, forming the typical caput medusae. They drain into the superficial or deep venous system. The frequent association with other, potentially bleeding-prone vascular malformations is clinically relevant, in particular cavernous angioma, which might require therapeutic action. Therefore, coincident vascular lesions need to be actively sought by appropriate additional imaging techniques.
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Affiliation(s)
- A Zimmer
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Germany.
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28
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Ukisu R, Kushihashi T, Tanaka E, Baba M, Usui N, Fujisawa H, Takenaka H. Diffusion-weighted MR imaging of early-stage Creutzfeldt-Jakob disease: typical and atypical manifestations. Radiographics 2007; 26 Suppl 1:S191-204. [PMID: 17050516 DOI: 10.1148/rg.26si065503] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Creutzfeldt-Jakob disease causes progressive dementia and, eventually, death. The infectious agent is thought to be proteinaceous scrapie particles. Prompt diagnosis is essential to prevent human-to-human transmission. Progressive brain atrophy and areas of high signal intensity in the cerebral cortex and basal ganglia are well-known features of Creutzfeldt-Jakob disease depicted on T2-weighted magnetic resonance (MR) images. However, in the early stage of disease, the appearance of the brain on T2-weighted MR images often is normal, and it may be impossible on that basis to reach a diagnosis. Diffusion-weighted imaging therefore has gained attention as a useful modality for the early diagnosis of Creutzfeldt-Jakob disease. Even before the appearance of the characteristic periodic synchronous discharges on the electroencephalogram, diffusion-weighted images in most cases of Creutzfeldt-Jakob disease depict areas of abnormal signal hyperintensity in the cortex and in the basal ganglia or thalamus. These imaging abnormalities are accompanied by decreased apparent diffusion coefficient values suggestive of restricted diffusion within the tissue. However, if diffusion-weighted imaging findings of abnormal high signal intensity are restricted to the cerebral cortex, it may be necessary to differentiate between Creutzfeldt-Jakob disease and other conditions that may produce progressive dementia (eg, venous hypertensive en-cephalopathy; chronic herpes encephalitis; and the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes).
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Affiliation(s)
- Ryutarou Ukisu
- Department of Radiology, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuou, Tsuzuki-ku, Yokohama 224-8503, Japan.
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29
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Seki Y, Sahara Y. Spontaneous Thrombosis of a Venous Malformation Leading to Intracerebral Hemorrhage -Case Report-. Neurol Med Chir (Tokyo) 2007; 47:310-3. [PMID: 17652917 DOI: 10.2176/nmc.47.310] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 33-year-old man presented with consciousness disturbance (Glasgow Coma Scale score 7) and right hemiplegia after suffering headache persisting for 10 days. Head computed tomography revealed an irregular intracerebral hematoma in the left temporoparietal region, associated with a tubular high density area compatible with a thrombosed transcerebral vein in the left temporal lobe. The patient was free of coagulopathy. Craniectomy was performed to remove the intracerebral hematoma and venous thrombosis was confirmed. Postoperative cerebral angiography demonstrated extensive venous malformation in the left parietal and occipital lobes. Multiple transcerebral draining veins converged in the vein of Galen associated with a varix. Segmental narrowing of the straight sinus was suggestive of congestion in the venous anomaly. The patient showed progressive recovery following surgery, and was discharged with moderate aphasia, mild right hemiparesis, and right homonymous hemianopsia 1 month later. Venous malformations are usually silent, but occasionally become symptomatic due to thrombosis of the draining vein. The presence of stenosis in the draining route may lead to venous congestion, thrombus formation, and catastrophic hemorrhagic venous infarct.
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Affiliation(s)
- Yukio Seki
- Department of Neurosurgery, Chubu Rosai Hospital, Nagoya, Japan.
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30
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Fok KF, Holmin S, Alvarez H, Ozanne A, Krings T, Lasjaunias PL. Spontaneous intracerebral hemorrhage caused by an unusual association of developmental venous anomaly and arteriovenous malformation. Interv Neuroradiol 2006; 12:113-21. [PMID: 20569563 DOI: 10.1177/159101990601200205] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 05/15/2006] [Indexed: 11/16/2022] Open
Abstract
SUMMARY We describe three patients who presented with spontaneous intracerebral hemorrhage resulting from the close association of developmental venous anomaly (DVA) and arteriovenous malformation (AVM). Angioarchitecturally, either the DVA formed the draining pathway for the AVM or they shared a common venous channel. The AVMs were treated by targeted embolization and the DVAs were carefully preserved. It is suggested that the unusual association of an AVM with the less flexible DVA was the cause of hemorrhage.
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Affiliation(s)
- K F Fok
- From the Service de Neuroradiologie Diagnostique et Thérapeutique, CHU Le Kremlin Bicêtre, Paris, France - pierre.lasjauniasct.ap-hop-paris.fr
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31
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Peltier J, Toussaint P, Desenclos C, Le Gars D, Deramond H. Cerebral venous angioma of the pons complicated by nonhemorrhagic infarction. J Neurosurg 2004; 101:690-3. [PMID: 15481728 DOI: 10.3171/jns.2004.101.4.0690] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors emphasize an unusual complication of venous angiomas in the brain: venous infarction. The patient in this case is a 32-year-old man who presented with a clinical history of headache followed by a worsening of his neurological status. Neuroimaging studies demonstrated a brain infarct in the posterior fossa, which was related to thrombosis of the draining vein of a cerebral venous angioma. A conservative treatment approach without anticoagulation therapy was followed and the patient completely recovered. Nonhemorragic venous infarction caused by thrombosis of a venous angioma is exceptional and only nine previous cases have been reported in the literature.
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Affiliation(s)
- Johann Peltier
- Departments of Neurosurgery and Neuroradiology, University Hospital Center, Amiens, France.
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