Thrombosis of a Developmental Venous Anomaly Causing Venous Infarction and Pontine Hemorrhage

doi:10.1016/j.jstrokecerebrovasdis.2013.04.033

Journal of Stroke and Cerebrovascular Diseases

Volume 22, Issue 8, November 2013, Pages e653-e655

https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.04.033 Get rights and content

Developmental venous anomalies are often incidental findings on brain imaging. We report a case of a thrombosed developmental venous anomaly with venous congestion and pontine hemorrhage that improved after anticoagulation therapy.

Section snippets

Discussion

DVAs are the most commonly observed cerebral vascular malformations, with an incidence rate of >2%.¹ While DVAs are frequently found in the posterior fossa, presence within the brainstem is relatively rare.2, 3, 4, 5 Most brainstem DVAs drain into the dural sinuses, petrosal vein, or vein of Galen.² They are usually benign variations in the network of transmedullary veins.6, 7

DVAs can produce symptoms either by venous congestion related to flow obstruction⁸ or mechanical compression (e.g.,

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Cited by (15)

Pontocerebellar venous infarction caused by COVID-19 in a 13-year-old girl with underlying asymptomatic developmental venous anomaly
2022, Neuroimmunology Reports
COVID-19-associated coagulopathy (CAC) presents as a highly activated thrombotic status, leading to severe clinical outcomes. We report a unique pediatric case of pontocerebellar venous infarction caused by COVID-19 (omicron mutation) and accompanied by abnormal brain venous structure.
A 13-year-old unvaccinated girl with high-grade fever and altered mental status visited our emergency department. In her initial serologic results, all the inflammatory markers were elevated; interleukin-6 was remarkably elevated (above 5000 pg/mL). On brain CT, a suspicious subtle hypo-attenuated lesion in the right interior cerebellar hemisphere area was observed; brain MRI revealed bilateral asymmetric hyperintense lesions in the mid-pons, and extensive cerebellar hemorrhage and engorged venous structure. Despite intensive medications and treatments, the patient failed to maintain her vital signs with a mechanical ventilator because of aggravated pneumonia and bilateral pleural effusion, and she died ten days after her hospital admission.
In our patient, a rapid systemic cytokine storm reaction occurred, and presumably, the resulting inflammation sequentially caused the coagulopathy cascade. One of the significant risk factors was an asymptomatic developmental venous anomaly (DVA) of the cerebellum. The asymptomatic DVA concomitant with COVID-19 may be associated with thrombosis and needs further brain imaging studies.
Serial imaging and SWAN sequence of developmental venous anomaly thrombosis with hematoma: Diagnosis and follow-up
2017, Journal of Clinical Neuroscience
Citation Excerpt :
To-day only 29 cases of symptomatic thrombosed DVAs are reported. 9 presented with parenchymal hemorrhage and were explored with MRI [1–9], 4 with GRE [3,5,7–9]. GRE could not identify the transmedullary veins.
Diagnostic Imaging: Brain
2016, Diagnostic Imaging: Brain
Imaging in Neurology
2016, Imaging in Neurology
Surgical Cavernous Malformations and Venous Anomalies
2015, Stroke: Pathophysiology, Diagnosis, and Management
Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery
2023, Frontiers in Neurology

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Case ReportThrombosis of a Developmental Venous Anomaly Causing Venous Infarction and Pontine Hemorrhage

Section snippets

Discussion

Intracerebral venous angioma. Case report and review

Arch Neurol

Developmental venous anomalies of the posterior fossa with transpontine drainage: Report of 3 cases

Eur Radiol

Developmental venous anomaly of the pons

Neurology

MR evaluation of developmental venous anomalies: Medullary venous anatomy of venous angiomas

AJNR Am J Neuroradiol

Posterior fossa venous angiomas with drainage through the brain stem

AJNR Am J Neuroradiol

Developmental venous anomalies (DVA): The so-called venous angioma

Neurosurg Rev

The trans-cerebral veins: Normal and non-pathologic angiographic aspects

Surg Radiol Anat

Pathomechanisms of symptomatic developmental venous anomalies

Stroke

Thrombosis of a drainage vein in developmental venous anomaly (DVA) leading venous infarction: A case report and review of the literature

J Neuroimaging

Case Report
Thrombosis of a Developmental Venous Anomaly Causing Venous Infarction and Pontine Hemorrhage