INTRACEREBRAL HEMORRHAGE / VASCULAR MALFORMATIONS
Cerebral venous angioma (DVA)
Created 20/04/2021, last revision 29/04/2023
- 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
Clinical presentation
- commonly asymptomatic, incidental finding
- epileptic seizures
- headaches
- venous infarction (in case of thrombosis of the draining vein)
- intracerebral bleeding is rare (0.2-0.4% per year)
- the increased risk is connected with occlusion of the draining vein, e.g., due to thrombosis [Agarwal, 2014]
- search for an associated cavernous malformation (cavernoma)
Diagnostic evaluation
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Differential diagnosis
- sometimes there is an atypical imaging appearance which may be confounded by concurrent pathology
- dural arteriovenous fistula (DAVF)
- arteriovenous malformation (AVM)
- dural sinus thrombosis
- Sturge-Weber syndrome
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
