Case reportsĪ 27-year-old woman who presented with a sensorineural hearing loss followed by facial paresis. There were no haemorrhages over a median period of 3.8 years of prospective follow-up 2). The relative risk of a cerebellar DVA haemorrhage compared to its supratentorial counterpart was 5.35 (OR 6.8, 95% CI 0.8-58).ĭVA-related haemorrhage is sevenfold greater in the paediatric cohort compared to adults and is significantly associated with a cerebellar location and cavernous malformations. Left-sided DVA haemorrhages predominated (3/4, 75%). The ages of the children with DVA-related haemorrhages were 21 days, 2 years and 6 months, 7 years and 1 month and 11 years and 7 months. Four patients (7.7%) suffered DVA-related intracranial haemorrhage presenting with neurological deficits. There were three deaths unrelated to DVAs over median follow-up of 3.8 years. Associated cavernous malformations (CMs) were present in 3/52 (5.8%), and no DVAs were associated with aneurysms or arteriovenous malformations (AVMs). Temporal (11.5%), parietal (9.6%) and occipital (5.8%) were the remainder. Overall, anatomical distribution revealed predilection for frontal region (42.3%) with other common sites being posterior fossa (17.3%) and basal ganglia (13.5%). The majority (92.3%) presented with asymptomatic DVAs identified incidentally. Case seriesįifty-two children (20 boys and 32 girls were identified with DVAs. Surgery for the angioma itself is reserved only for documented bleeding or for intractable seizures that can be definitely attributed to the lesion. If surgery is indicated for associated cavernous malformations, the angioma should be left alone. In general, these should not be treated, as they are the venous drainage of the brain in that vicinity. Diagnosisĭevelopmental venous anomaly diagnosis. ~20% (range 8-33%) of cases 2 are associated with cavernous malformations and are referred to as mixed vascular malformations (MVM) there is an association with venous malformations of the head and neck. Lesions are usually solitary (75%), except in blue rubber bleb naevus syndrome ![]() However, DVAs can be seen anywhere, draining either superficially or deep. Histologically they consist of a number of abnormally thickened veins with normal feeding arteries and capillaries Classificationįrontoparietal region (36-64%) 1, usually draining towards the frontal horn of the lateral ventricleĬerebellar hemisphere (14-27%) draining towards the fourth ventricle The aetiology of VAs remains uncertain, but may relate to arrested development of venous structures The appearance has also been likened to a palm tree. They were thought to be rare before cross-sectional imaging but are now recognised as being the most common cerebral vascular malformation, accounting for ~55% of all such lesions.Ī venous anomaly is characterized by the caput medusae sign of veins draining into a single larger collecting vein, which in turn drains into either a dural sinus or into a deep ependymal vein. They have mostly supplanted the more pedestrian venous angioma 1).Ĭongenital malformation of veins which drain normal brain. If symptoms are present, look for an associated cavernous malformation ( GRASS MRI images may reveal some cavernous malformations that might otherwise be occult). Venous infarcts have been described, but maybe coincidental. ![]() Most are clinically silent, but rarely seizures and even less frequently hemorrhage may occur. They may be associated with a cavernous malformation. Most common in regions supplied by the MCA or in the region of the vein of Galen. There is neural parenchyma between the vessels. The veins lack large amounts of smooth muscle and elastic. A tuft of medullary veins that converge into an enlarged central trunk that drains either to the deep or superficial venous system. may have an associated cavernous malformation which is more likely to be symptomaticĭevelopmental venous anomaly (DVA) AKA venous malformation or (developmental) venous angioma.Venous infarcts may occur (controversial) rarely symptomatic: seizures rare, hemorrhage even more uncommon. ![]() usually demonstrable on angiography as a starburst pattern.Therefore direct treatment is rarely indicated a vascular malformation that is part of the venous drainage of the involved area with intervening brain present. ![]() Developmental venous anomaly Key concepts
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |