Developmental venous anomaly
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Presentation
The patient presented with headache for one week and three episodes of fitting. No fever, photophobia, or neck stiffness.
Patient Data
Ill-defined hypodensity is seen at the right cerebellum with the blurring of adjacent grey-white matter differentiation. Associated with partial effacement of the right lateral cerebellomedullary cistern.
No intracranial bleeding.
No midline shift. Ventricles, CSF spaces, and the rest of the basal cisterns are preserved.
No hydrocephalus.
Numerous small curvilinear venous structures in the right cerebellum converge into larger collecting veins giving the characteristic caput medusae sign draining into the right petrosal sinus.
T2/FLAIR hyperintense signal with no restricted diffusion or definite enhancement is seen at the adjacent right cerebellar parenchyma, likely vasogenic edema. Associated with partial effacement of right lateral cerebellomedullary cistern and right cerebellar folii.
No blooming artifact on SWI to suggest microhemorrhage.
Myelination is appropriate for the patient's age. Midline structures and pituitary glands are unremarkable. No evidence of grey matter heterotopia.
No midline shift. Ventricles, CSF spaces and rest of basal cistern are preserved. No hydrocephalus.
Under pneumatization of bilateral frontal sinuses. The rest of paranasal sinuses and both mastoid air cells are clear.
Case Discussion
This is a case of developmental venous anomalies at right cerebellum evidenced by caput medusae sign of veins draining into larger collecting veins. The adjacent right cerebellar parenchymal edema is likely related to venous congestion.
Developmental venous anomalies is a congenital entity and known as cerebral venous angioma as well.
It could be an incidental finding. However, it can also associated with epilepsy, stroke or intracranial bleed.
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