Vein of Galen malformation

Case contributed by Dr Jeremy Jones

Presentation

Neonate with high output cardiac failure. Antenatal imaging demonstrated an intracranial abnormality.

Patient Data

Age: 2 days
Gender: Male
Ultrasound

Large midline dilated highly vascular abnormality centered above the cerebellum. Features are of a Vein of Galen malformation.

MRI

The huge midline vascular malformation is demonstrated as a flow void on T2 weighted imaging and is seen to fill with contrast. Features are of a vein of Galen malformation.

DSA (angiography)

High flow vascular malformation shunts virtually all the injected contrast media directly into the venous sinuses posteriorly.

X-ray

Following coiling, the aneurysm sac is filled with metalic coils. Previous contrast injected had confirmed that flow had been obliterated.

Case Discussion

On of the differentials for high output cardiac failure in a neonate is a high-flow vascular malformation with a shunt. A vein of Galen malformation is one such malformation and results in large volumes of blood being shunted through the posterior circulation of the brain.

If diagnosed early, given appropriate supportive medical therapy and transferred to a regional centre of excellence, the vein of Galen malformation can be coiled.

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Case information

rID: 32194
Case created: 18th Nov 2014
Last edited: 22nd Jan 2016
Inclusion in quiz mode: Included

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