Vein of Galen malformation

Case contributed by Dr Naim K

Presentation

Seizure, headache, and vomiting to rule out intracranial pathology.

Patient Data

Age: 7 years
Gender: Male
MRI

Brain

There are large arteriovenous malformations seen in the left parietal lobe parasagittal in location with multiple signal void vessels draining into the vein of Galen and straight sinus. Vein of Galen aneurysm is seen in the cistern of velum interpositum.

The main arterial blood supply is from the left anterior cerebral artery.

Hydrocephalus with significant intraventricular hemorrhage in both lateral ventricles extending into the third and fourth ventricles.

NB:

Mucosal thickening of all paranasal sinuses is seen, consistent with pansinusitis.

Case Discussion

A 7-year-old boy presented with headache, seizures, and vomiting to A&E. MRI was requested to rule out intracranial pathology. The study revealed appearances of Vein of Galen aneurysmal malformation (VGAM), a rare congenital arteriovenous malformation.

It is one of the differentials for midline cystic lesions detected on perinatal head ultrasonography. VGAM takes up signal on color Doppler interrogation and shows pulsatile flow within it. It is seen posterior to the third ventricle in the cistern of the velum interpositum.

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