J Korean Soc Radiol.  2017 Jun;76(6):420-424. 10.3348/jksr.2017.76.6.420.

Venous Infarction of Developmental Venous Anomaly: A Case Report with Perfusion Imaging

• Kim JY
• Kim HJ
• Kim ES
• Hyun SJ
• Kim HY
• Kim HM
• Hwang JY
• Hong HS
• Woo JY
• Yang I

• KMID: 2379324
• DOI: http://doi.org/10.3348/jksr.2017.76.6.420

Abstract

Developmental venous anomaly (DVA) is a common congenital venous malformation characterized by dilated medullary veins in caput medusa configuration and a draining vein. Despite the high incidence of DVAs, they are benign anatomic variations and rarely cause symptoms. Here, we report computed tomography and magnetic resonance imaging findings with perfusion images of acute infarction from underlying DVA in a 63-year-old female patient who presented with acute onset of neurologic symptoms and recovered without any neurologic deficit.

MeSH Terms

Central Nervous System Venous Angioma
Female
Humans
Incidence
Infarction*
Magnetic Resonance Imaging
Middle Aged
Neurologic Manifestations
Perfusion Imaging*
Perfusion*
Veins

Figure

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  Fig. 1 Venous infarction of developmental venous anomaly in a 63-year-old woman who presented with an acute onset of right side motor weakness and sensory changes. Axial, non-enhanced (conventional) computed tomography (A) revealed a subtle hypodense area (black arrow) in the left basal ganglia compared to the contralateral side. Gadolinium-enhanced T1-weighted axial images displayed the enhancement of medullary veins (white arrow, B) at the left putamen in the ‘caput medusa’ configuration with a collector vein (white arrowhead, C) draining to the eft lateral ventricle's surface. Diffusion weighted images (D, E) showed hyperintense lesions in left basal ganglia and periventricular white matter nearby the draining vein. A corresponding diffusion coefficient map (F, G) demonstrated diffusion restrictions, indicating acute infarction. Perfusion images revealed a regional increase of relative cerebral blood flow (H, I) and of cerebral blood volume (J, K), surrounding the developmental venous anomaly, with a prolongation of mean transit time (L, M) and time to peak (N, O).

Reference

1. Truwit CL. Venous angioma of the brain: history, significance, and imaging findings. AJR Am J Roentgenol. 1992; 159:1299–1307.

2. Lasjaunias P, Burrows P, Planet C. Developmental venous anomalies (DVA): the so-called venous angioma. Neurosurg Rev. 1986; 9:233–242.

3. Töpper R, Jürgens E, Reul J, Thron A. Clinical significance of intracranial developmental venous anomalies. J Neurol Neurosurg Psychiatry. 1999; 67:234–238.

4. Pereira VM, Geibprasert S, Krings T, Aurboonyawat T, Ozanne A, Toulgoat F, et al. Pathomechanisms of symptomatic developmental venous anomalies. Stroke. 2008; 39:3201–3215.

5. Griffiths D, Newey A, Faulder K, Steinfort B, Krause M. Thrombosis of a developmental venous anomaly causing venous infarction and pontine hemorrhage. J Stroke Cerebrovasc Dis. 2013; 22:e653–e655.

6. Masson C, Godefroy O, Leclerc X, Colombani JM, Leys D. Cerebral venous infarction following thrombosis of the draining vein of a venous angioma (developmental abnormality). Cerebrovasc Dis. 2000; 10:235–238.

7. Field LR, Russell EJ. Spontaneous hemorrhage from a cerebral venous malformation related to thrombosis of the central draining vein: demonstration with angiography and serial MR. AJNR Am J Neuroradiol. 1995; 16:1885–1888.

8. Ruíz DS, Yilmaz H, Gailloud P. Cerebral developmental venous anomalies: current concepts. Ann Neurol. 2009; 66:271–283.

9. Konan AV, Raymond J, Bourgouin P, Lesage J, Milot G, Roy D. Cerebellar infarct caused by spontaneous thrombosis of a developmental venous anomaly of the posterior fossa. AJNR Am J Neuroradiol. 1999; 20:256–258.

10. Jung HN, Kim ST, Cha J, Kim HJ, Byun HS, Jeon P, et al. Diffusion and perfusion MRI findings of the signal-intensity abnormalities of brain associated with developmental venous anomaly. AJNR Am J Neuroradiol. 2014; 35:1539–1542.