INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS

Venous angioma (DVA)

Created 08.12.2019 , last update 21.12.2021

  • cerebral venous angioma / Developmental Venous Anomaly (DVA) is a congenital malformation where dilated veins with no abnormal feeding artery (caput medusae sign) converge into a single large abnormal draining vein
  • DVAs rarely bleed  ⇒ if  a hemorrhage is present, look for associated cavernous malformation (15-20%), AVM, or a tumor
  • most commonly, DVAs are in the parietal and frontal lobes (up to 64%) and cerebellum (up to 30%)
    • supratentorial drainage ⇒ superficial or deep subependymal veins
    • infratentorial drainage ⇒ the transverse sinus, the great vein of Galeni, petrous sinus   → intracranial venous system see here
Venous angioma (Developmental venous anomaly)

Clinical presentation

  • commonly asymptomatic, incidental finding
  • epileptic seizures
  • headaches
  • venous infarction (in case of thrombosis of the draining vein)
  • intracerebral hemorrhage is rare (0.2-0.4% per year)

Diagnostic evaluation

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Differencial diagnosis

Management

  •  a conservative approach is common for isolated DVA
  • the draining vein often serves as drainage for the surrounding unaffected areas
    • its surgical occlusion or spontaneous thrombosis may lead to venous infarction
  • if needed, treat concurrent malformation
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