Developmental venous anomaly

Case contributed by Dr Henry Knipe

Presentation

Sudden onset headache.

Patient Data

Age: 40 years
Gender: Male
CT

Ill-defined hyperdensity seen in the inferior left frontal deep white matter and caudate head. No other abnormality identified. 

CT

Branching venous structure in the inferior left frontal lobe, corresponds to the hyperdense abnormality on the non-contrast CT. 

MRI

Branching structure centred in the deep white matter of the inferior frontal lobe, adjacent to the caudate head and insular cortex. It has a typical "palm tree" appearance of a developmental venous anomaly, which appears to drain via to the left cavernous sinus and to a superficial cortical vein. Surrounding the branching DVA is a small amount of high FLAIR signal.

Loss of grey-white differentiation in the left caudate head, with blooming artifact on susceptibility weighted imaging involving the left caudate head, anterior limb of internal capsule, and lentiform nucleus.

High FLAIR foci in the supratentorial deep white matter, mostly frontal distribution.

MRA demonstrates is normal.

DSA (angiography)

Left frontal vascular anomaly with a prominent draining vein, most in keeping with a developmental venous anomaly. No early venous filling to suggest AV shunting.

Case Discussion

Findings on the CT angiogram are fairly characteristic of a developmental venous anomaly. These are most often an incidental finding and are only uncommonly symptomatic. DVAs have a close associated with cavernomas, while one is not distinctly identified on the MRI there is triangular-shaped susceptibility artifact adjacent to the DVA, which is probably due to old haemorrhage possibly from an underlying cavernoma. In this case the DVA is thought to be incidental to presentation. 

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Case information

rID: 49223
Case created: 16th Nov 2016
Last edited: 3rd Mar 2017
Inclusion in quiz mode: Included

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