Atormac
Neurology India
Open access journal indexed with Index Medicus
  Users online: 330  
 Home | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (833 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed116    
    Printed3    
    Emailed0    
    PDF Downloaded15    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 5  |  Page : 1505-1506

A rare case of spontaneous thrombosis of vein of Galen malformation in a young adult diagnosed on magnetic resonance imaging and digital subtraction angiography


Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana, India

Date of Web Publication17-Sep-2018

Correspondence Address:
Dr. Gaurav Goel
Department of Neurosciences, Medanta, The Medicity, Gurgaon, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.241344

Rights and Permissions



How to cite this article:
Mahajan A, Goel G, Das B, Narang KS. A rare case of spontaneous thrombosis of vein of Galen malformation in a young adult diagnosed on magnetic resonance imaging and digital subtraction angiography. Neurol India 2018;66:1505-6

How to cite this URL:
Mahajan A, Goel G, Das B, Narang KS. A rare case of spontaneous thrombosis of vein of Galen malformation in a young adult diagnosed on magnetic resonance imaging and digital subtraction angiography. Neurol India [serial online] 2018 [cited 2018 Oct 23];66:1505-6. Available from: http://www.neurologyindia.com/text.asp?2018/66/5/1505/241344




Sir,

A 30-year old male patient presented with complaints of severe headache for 15 days not relieved by medication. He had no significant medical history. Magnetic resonance imaging (MRI) showed a hyperintense oval lesion in the quadrigeminal cistern and a curvilinear hyperintensity in the third ventricular region, which were in continuation with each other on fluid attenuated inversion recovery image and T1-weighted image [Figure 1]a-c]. MRI findings were suggestive of thrombosed vein of Galen and bilateral internal cerebral veins. The patient underwent digital subtraction angiography (DSA), which showed a prominent left posterior cerebral artery (PCA) with associated flow-related aneurysm in the P1 segment of left PCA. There was a prominent left posteromedial choroidal artery showing slow anterograde flow with stasis of contrast in the delayed capillary and venous phase. There was also non-opacification of the deep venous system in the venous phase [Figure 2]a-c]. The findings of DSA were suggestive of thrombosed vein of Galen malformation (VOGM). The patient was offered neither surgical nor endovascular treatment options, and was discharged and advised a repeat angiography at a follow up of 6 months to check for the regression of flow-related aneurysm in the P1 segment of left PCA.
Figure 1: Fluid attenuated inversion recovery, axial image (a and b) showed a hyperintense oval lesion (arrow) in the quadrigeminal cistern and a curvilinear hyperintensity (arrows) in the third ventricle region. T1-weighted sagittal image (c) showed an oval hyperintensity in continuation (arrow) with the curvilinear hyperintensity, suggestive of the thrombosed vein of Galen aneurysm and internal cerebral veins

Click here to view
Figure 2: Left vertebral artery injection. Arterial phase (a) showed a relatively prominent left PCA (red arrow) and a small flow-related aneurysm (yellow arrow) in P1 segment of left PCA. Late capillary phase (b) showed stasis of dye in the prominent left posterior medial choroidal artery (arrow). Venous phase (c) showed the stasis of dye in the left posterior medial choroidal artery (arrow) and non-opacification of the deep venous system

Click here to view


VOGM is a rare anomaly found in children.[1],[2],[3] It is an arteriovenous communication between the primitive choroidal vessels and the persistent median prosencephalic vein of Markowski.[4] Many classifications have been described in the literature. The most commonly used and accepted classification systems are those proposed by Yasargil [5] and Lasjaunias.[6] Yasargil described lesion types 1, 2, and 3, which are direct fistulae between the malformations and the vein of Galen. Lesion type 4 is a parenchymal arteriovenous malformation, which drains directly into the vein of Galen. Lasjaunias et al.,[6] divided these malformations into the choroidal and the mural types. The choroidal type is a high-flow type having multiple fistulae at the anterior and terminal segment of the median prosencephalic vein. The mural type is the slow-flow type having a fistula at the inferior wall of the median prosencephalic vein. The occurrence of VOGM is very rarely seen in adults and has been reported by some authors in the literature.[7],[8] Some authors [9],[10] have also reported the rare presentation of spontaneous thrombosis of VOGM in adults. In our case, there was spontaneous thrombosis of the choroidal type of VOGM, which was incidentally diagnosed on MRI and DSA. There are various risk factors described in the literature that are known to promote the thrombosis of VOGM.[9],[11],[12]

We report a rare case of spontaneous thrombosis of VOGM in a young adult who presented with severe headache. No treatment, including microsurgery and endovascular surgery, was offered to the patient in view of the spontaneous thrombosis of the malformation. This entity should be kept in the differential diagnosis of severe headache in a young adult.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Paumier A, Winer N, Joubert M, Yvinec M, Aubron F, Sagot S, et al. Galen vein aneurysm: Review of the literature and report of two cases. J Gynecol Obstet Biol Reprod (Paris) 1998;27:814-20.  Back to cited text no. 1
    
2.
Bohiltea RE, Turcan N, Mihalea C, Dorobat B, Cinteza EE, Dan A, et al. Ultrasound prenatal diagnosis and emergency interventional radiologic therapy of Galen aneurysmal malformation in a newborn. Maedica (Buchar) 2016;11:334-40.  Back to cited text no. 2
    
3.
Demartini Jr Z, Dos Santos MLT, Koppe GL, Cardoso-Demartini AA. Sinus thrombosis after endovascular treatment of vein of Galen aneurysmal malformation. Pediatr Neurosurg 2017;52:136-9.  Back to cited text no. 3
    
4.
Raybaud CA, Strother CM, Hald JK. Aneurysms of the vein of Galen: Embryonic considerations and anatomical features relating to the pathogenesis of the malformation. Neuroradiology 1989;31:109-28.  Back to cited text no. 4
    
5.
Yasargil MG. Microneurosurgery IIIB. New York: Thieme Medical Publishers; 1988. P 323-57.  Back to cited text no. 5
    
6.
Lasjaunias P, Ter Brugge K, Lopez Ibor L, Chiu M, Flodmark O, Chuang S, et al. The role of dural anomalies in vein of Galen aneurysms: Report of six cases and review of the literature. AJNR Am J Neuroradiol 1987;8:185-92.  Back to cited text no. 6
    
7.
Abe T, Matsumoto K, Kiyota K, Tanaka H. Vein of Galen aneurysmal malformation in an adult: A case report. Surg Neurol 1996;45:39-43.  Back to cited text no. 7
    
8.
Mylonas C, Booth AE. Vein of Galen aneurysm presenting in middle age. Br J Neurosurg 1992;6:491-4.  Back to cited text no. 8
    
9.
Marques RM, Lobão CA, Sassaki VS, Aguiar LR. Vein of Galen aneurysm in an adult: Case report. Arq Neuropsiquiatr 2006;64:862-4.  Back to cited text no. 9
    
10.
Abrão GP, Barbosa LA, Sá Jr AT, Caldas JG. Spontaneous thrombosis of a malformation of the vein of Galen. Arq Neuropsiquiatr 2010;68:648-50.  Back to cited text no. 10
    
11.
Kariyappa KD, Krishnaswami M, Gnanaprakasam F, Ramachandran M, Krishnaswamy V. Spontaneous thrombosis of vein of Galen malformation. J Pediatr Neurosci 2016;11:264-6.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Mohanty CB, Srinivas D, Sampath S. Spontaneous thrombosis of a vein of Galen malformation. Asian J Neurosurg 2016;11:69.  Back to cited text no. 12
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow