Developmental Venous Anomaly Presenting with Spontaneous Intracerebral Hemorrhage, Acute Ischemic Stroke, and Seizure

Abstract

Developmental venous anomaly (DVA) is the most common, benign, congenital vascular malformation of the brain and mostly an incidental finding on imaging. The exact etiology of DVA is unknown but thought to be due to medullary vein thrombosis during embryonic venous development. DVA is generally asymptomatic although associated neurologic deficits and seizures have been described. Several reports of DVA causing neurovascular compression, obstructive hydrocephalus, venous infarction, and intracerebral hemorrhage (ICH) have been described. In this report, we discuss a patient with fluctuating neurological symptoms found to have multiple DVA, predominantly draining into the deep venous system. To the best of our knowledge, DVAs leading to simultaneous ischemic stroke, intracerebral hemorrhage, and seizures are not reported in the literature. We reviewed the relevant literature and discussed the epidemiology and clinical and radiological characteristics of DVA.

Epilepsy and cerebral developmental venous anomalies (DVAs): A systematic review

“…Illustrative case from Mullaguri et al 32 These images were borrowed from the case report by Mullaguri et al on a 65‐year‐old male presenting with acute‐onset right‐sided weakness, gaze preference, and speech difficulties, who was found to have an acute left parietal hemorrhage with multiple DVAs and who eventually developed focal‐to‐bilateral seizures. (A) MRI DWI sequence showing acute infarction in the left frontal subcortical region (orange arrows).…”

“…A total of 39 studies were included after full‐text review, with 66 patients included for analysis 8–46 . Figure 1 presents the flow diagram detailing the selection process.…”

“…Antithrombotic medication was used in six (11%) cases. For the 12 cases in which surgery was performed, three (25%) were complete excisions of the DVA, two (17%) were partial excisions of the DVA, and the remaining seven (58%) were other types of surgeries that did not directly affect the DVA (e.g., decompressive craniectomy and F I G U R E 2 Illustrative case from Mullaguri et al 32 These images were borrowed from the case report by Mullaguri et al on a 65-year-old male presenting with acute-onset right-sided weakness, gaze preference, and speech difficulties, who was found to have an acute left parietal hemorrhage with multiple DVAs and who eventually developed focal-to-bilateral seizures. and a "halo" sign in the left frontal area around the veins in the infarction area (red circle).…”

“…and a "halo" sign in the left frontal area around the veins in the infarction area (red circle). 32 hematoma evacuation). Among the patients for whom a long-term follow-up was achieved, a seizure-free state was described in 18 (100%) individuals at 3 months, 15 (100%) at 6 months, and 12 (75%) at 12 months.…”

Hyperkinetic Choreiform Movements Secondary to Basal Ganglia Calcification and Underlying Developmental Venous Anomaly

“…Although common, DVA's are typically benign and asymptomatic. However, with advancing age they can progress, with ischemic and hemorrhagic stroke being rare complications [5,6]. Cerebral calcifications in association with DVA are infrequent in the literature.…”