Multimodal Imaging Follow-up of a Thrombosed Developmental Venous Anomaly: CT, CT Angiography and Digital Subtraction Angiography

Abstract

We report a rare case of thrombosed developmental venous anomaly (DVA) in a 31-year old male with hemorrhagic cerebral venous infarction at the initial clinical presentation. In this case, sequential CT, CT angiography and digital subtraction angiography demonstrated thrombotic obstruction of the venous drainage from DVA, its progressive recanalization and temporal evolution of the affected brain parenchyma. The relevant previous literatures were reviewed and summarized.

Paediatric presentation of intracranial haemorrhage due to thrombosis of a developmental venous anomaly

“…Cerebral catheter angiography of DVAs classically reveals radiating veins (eg, ‘caput medusae’) emptying into a deep vein or dural sinus. These are seen in the same phase as normal venous drainage 2–4 6–9. Early radiological identification can help in the initiation of appropriate therapy and prevent incorrect surgical management leading to further neurological demise.…”

“…Several distinguishing radiological findings can help differentiate a DVA from other pathologies. CT angiography is often the first study obtained on presentation and may show dilated linear enhancements or abnormal vasculature 6. MRI is often more useful and can reveal the presence of linear transcerebral flow voids, with satellite arrangement.…”

Atypical presentation of venous infarct

“…4 One-third of patients have parenchymal hemorrhage, which is more common in venous infarcts due to lack of smooth muscle in vein walls. 1,2 Current recommendations for treatment of DVA thrombosis are based on those for dural sinus thrombosis. In the absence of hemorrhage, systemic anticoagulation should be strongly considered to promote recanalization and to decrease propagation of the thrombus.…”