The Presentation and Clinical Course of Intracranial Developmental Venous Anomalies in Adults

Abstract

on behalf of the SIVMS Collaborators* Background and Purpose-Reported risks of hemorrhage from intracranial developmental venous anomalies (DVAs) vary, so we investigated this in a systematic review and population-based study. Methods-We systematically reviewed the literature (Ovid Medline and Embase to November 7, 2007) and selected studies of Ն20 participants with Ն1 DVA(s) that described their clinical presentation and/or their clinical course over a specified follow-up period. We also identified every adult first diagnosed with a DVA in Scotland from 1999 to 2003 and followed them in a prospective, population-based study. Results-Of 2068 articles detected by the literature search, 15 met our inclusion criteria and described clinical presentation, 8 of which also described the clinical course of DVAs. In the 15 studies of 714 people first presenting with a DVA, 61% were incidental findings, the mode of presentation was unclear in 23%, 6% presented with nonhemorrhagic focal neurological deficit, 6% had caused symptomatic hemorrhage, 4% were associated with epileptic seizure, and Ͻ1% were associated with infarction. In studies of the clinical course of 422 people with a DVA, the hemorrhage rate after first presentation ranged from 0% to 1.28% per year. In the population-based study of 93 adults with DVAs, 98% were incidental, 1% presented with symptomatic hemorrhage, and 1% presented with an infarct, but there were no symptomatic hemorrhages or infarcts in 492 person-years of follow-up (0% per person-year; 95% CI, 0% to 0.7%).

Brain Metabolic Abnormalities Associated with Developmental Venous Anomalies

“…The association of DVAs and seizure has been previously reported 23 ; however, to the best of our knowledge, this is the first report to observe hypermetabolic activity near the region of a DVA on FDG-PET. The concordance between the PET and MR imaging findings further suggests that DVAs may be epileptogenic.…”

The association between cerebral developmental venous anomaly and concomitant cavernous malformation: an observational study using magnetic resonance imaging

“…DVAs have a benign clinical course [6], and the reported incidence is 0.05-3% based on enhanced imaging and autopsy in the general population [6-10]. CM is a vascular lesion that lacks the features of arteries or veins [11,12].…”

New Trends in Management of Epilepsy in Patients with Cerebral Venous Malformations: Our Experience

“…[21,37] DVAs may present with headache, seizure, dizziness, and ataxia. [35,[38][39][40] Prospective studies on venous angiomas have demonstrated a very low rate of both symptomatic hemorrhage (0.34% per year) and neurologic symptoms; bleeding, when it rarely occurs, has been hypothetically blamed on putative neighboring cavernous malformations. [41] Blood flow through venous angiomas is low, and they are thought to drain normally from the brain.…”

“…[35,44,45] In most of the cases, DVAs were located in a different region with respect to the focus of the seizure [9,45] or there was another lesion found that could be the cause of epilepsy. [38] DVAs have been reported to be associated usually with generalized seizures, [44,46] but some patients have experienced partial seizures, [44,47] complex partial seizures [46] or even Jacksonian march of motor seizures. [1] Although cases of existence of DVAs and seizures have been reported, the correlation between them has not been firmly determined.…”

“…[1] Although cases of existence of DVAs and seizures have been reported, the correlation between them has not been firmly determined. [15,22,38,41,45] The study of Striano et al [15] revealed that DVAs are rarely found in epileptic patients, as distinct from other vascular malformations, cavernomas in particular. Topographic and/or etiological relationships between DVA and epilepsy are still undefined.…”