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LETTERS TO EDITOR
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 604-605

An intracranial developmental venous anomaly presenting with seizure


Department of Neurosurgery, School of Medicine, Adiyaman University, Adiyaman, Turkey

Date of Web Publication13-May-2019

Correspondence Address:
Dr. Necati Ucler
Department of Neurosurgery, School of Medicine, Adiyaman University, Adiyaman
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.258034

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How to cite this article:
Ucler N. An intracranial developmental venous anomaly presenting with seizure. Neurol India 2019;67:604-5

How to cite this URL:
Ucler N. An intracranial developmental venous anomaly presenting with seizure. Neurol India [serial online] 2019 [cited 2019 Jul 16];67:604-5. Available from: http://www.neurologyindia.com/text.asp?2019/67/2/604/258034




Sir,

Intracranial developmental venous anomalies (DVAs), otherwise known as venous malformations or venous angiomas, are assumed to be congenital abnormalities of venous drainage through which blood flows at a low velocity. DVAs sometimes coexist with other intracranial vascular malformations, usually cavernous malformations of the brain.[1],[2] The DVAs have no proliferative potential, no direct arteriovenous shunts and normal brain parenchyma exists between the dilated veins.[3] DVAs serve as normal drainage routes of the brain tissue because the habitual venous drainage of their territory is absent. DVAs are benign anatomic variations and are, therefore, usually incidentally discovered.

In this case report, we presented a 67-year-old male patient who was admitted due to the presence of new onset, intractable seizures. His psychomotor development was normal, and his personal and family history was unremarkable.

Magnetic resonance imaging (MRI)-angiography, computed tomographic angiography and digital subtraction angiography showed abnormal veins resembling caput medusae in the left parietal lobe and a dilated right Sylvian vein [Figure 1], [Figure 2], [Figure 3]. The diagnosis of a cerebral venous angioma was made based on these angiographic findings.
Figure 1: Computed tomographic angiography showing abnormal veins resembling caput medusae in the left parietal lobe along with a dilated right Sylvian vein

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Figure 2: Digital subtraction angiography showing abnormal veins resembling caput medusae in the left parietal lobe along with a dilated right Sylvian vein

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Figure 3: MRI angiography showing abnormal veins resembling caput medusae in the left parietal lobe and a dilated right Sylvian vein

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His history and data obtained by long-term video/electroencephalography recording suggested that the main type of seizure was a complex partial seizure. The patient was treated conservatively by controlling the blood pressure and headache. The patient has been seizure-free for 14 months after initiating the anticonvulsant therapy.

Although in the past, different clinical symptoms were attributed to be caused by DVAs, MRI has changed the understanding of DVA's natural history and associated clinical symptoms; most hemorrhages are related to the associated cavernomas rather than to the DVA per se. Epilepsies are due to associated cortical dysplasias, and pseudotumoral effects can be secondary to associated lymphatic malformations. DVA rarely causes symptoms, such as bleeding, seizure, hemifacial spasm, trigeminal neuralgia, aqueduct compression, nonhemorrhagic infarction and thrombosis of the draining vein.

The most common angiographic features of venous angiomas are deep medullary veins with a caput medusae appearance, accompanied by a collecting vein draining into the superficial cortical veins or the dural venous sinus. Computed tomography shows the venous angioma as a region of linear enhancement in the deep white matter, and MRI shows a flow void.[4]

A DVA is a benign vascular pathology. If there is an intracerebral pathology (i.e., a cavernoma or a seizure-inducing hippocampal atrophy) or any other neurologic patholgy associated with the DVA, firstly we should focus on the main pathology rather than the DVA, but the latter should be kept in mind as a possible differential diagnosis as well. We believe that surgery should be avoided in asymptomatic patients.

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.
Abdulrauf SI, Kaynar MY, Awad IA. A comparison of the clinical profile of cavernous malformations with and without associated venous malformations. Neurosurgery 1999;44:41-6.  Back to cited text no. 1
    
2.
San Milla'n Ruíz D, Delavelle J, Yilmaz H, Gailloud P, Piovan E, Bertramello A, et al. Parenchymal abnormalities associated with developmental venous anomalies. Neuroradiology 2007;49:987-95.  Back to cited text no. 2
    
3.
Ostertun B, Solymosi L. Magnetic resonance angiography of cerebral developmental venous anomalies: Its role in differential diagnosis. Neuroradiology 1993;35:97-104.  Back to cited text no. 3
    
4.
Moritake K, Handa H, Mori K, Ishikawa M, Morimoto M, Takebe Y. Venous angiomas of the brain. Surg Neurol 1980;14:95-105.  Back to cited text no. 4
    


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