Go Back Brain/13. Brain and meninges, Supratentorial/Vascular Disorder/13.7 DVA DEVELOPMENTAL VENOUS ANOMALY/ Go to Index

PATIENT COMPLAINS OF CEPHALGIA

DVADEVELOPMENTAL VENOUS ANOMALY

DEFINITION: A NETWORK OF DILATED MEDULLARY VEINS THAT CONVERGE IN A RADIAL FASHION AND DRAIN INTO EITHER DEEP OR SUPERFICIAL VEINS WITH SURROUNDING NORMAL BRAIN PARENCHYMA

HYPOTHESIS: THESE ANOMALOUS VEINS MAY REPRESENT AN ANATOMIC VARIANT OF VENOUS DRAINAGE OF PERIEPENDYMAL ZONES.

DVADEVELOPMENTAL VENOUS ANOMALY

DVAs PROVIDE COMPENSATORY DRAINAGE ROUTE FOR NORMAL BRAIN.

THESE ARE CLASSICALLY NOT SURGICAL LESIONS BECAUSE SACRIFICE OF THIS DRAINAGE PATHWAY CAN PRODUCE VENOUS INFARCT.

DVA

DO NOT RECOMMEND SURGERY UNLESS YOU WANT TO GO WITH THIS GUY!

DVA PRESENTATION AND INCIDENCE

PRESENTATION: The most frequent presentations included headache (50.8%), focal neurologic deficits (39.7%), and seizure (30.2%). Prevalence of headache and seizure decreased over time without treatment of the lesion. 1

INCIDENCE: Postmortem study (1978) utilizing 4069 serial cases reported an incidence of 2.5%.2

1. NJ Naff, J Wemmer, K Hoenig-Rigamonti and DR Rigamonti. A longitudinal study of patients with venous malformations.

Neurology 1998;50:1709-1714

2. Sarwar M, McCormick WF. Intracerebral venous angioma. Arch Neurol 1978;35:323-325

IMAGING CHARACRERISTICS

Medusa Head (dilated medullary veins) draining into larger vein transversing to deep ependymal vein or dural sinus is the best diagnostic clue

Typical periventricular location most common near frontal horn also seen adjacent to fourth ventricle

Usually solitary may be multiple in blue rubber bleb nevus syndrome (Multiple venous anomalies classically cutaneous , other organs may be affected particularly visceral as well as intracranial lesions)

RADIOLOGY FINDINGS

CECT: LINEAR OR DOT-LIKE ENHANCING STRUCTURES COVERGING TO A SINGLE LARGER VEIN

MR: T1- NORMAL IF DVA SMALL OTHERWISE VARYING SIGNAL WITH OR WITHOUT FLOW VOID

T2- +/- FLOW VOID

FLAIR- MAY SHOW HYPERINTENSITY IF ISCHEMIA PRESENT

T1+C- STRONG ENHANCEMENT STELLATE TUBULAR VESSELS

ANGIOGRAPHY: ARTERIAL PHASE NORMAL

CAPILLARY PHASE USUALLY NORMAL (RARE PROMINENT BLUSH)

VENOUS PHASE MEDUSA HEAD