Entezami Pouya, Boulos Alan, Yamamoto Junichi, Adamo Matthew
Neurosurgery, Albany Medical Center, Albany, New York, USA.
BMJ Case Rep. 2019 Jan 17;12(1):bcr-2018-227362. doi: 10.1136/bcr-2018-227362.
Developmental venous anomalies (DVAs) are the most commonly encountered cerebral malformations. While generally asymptomatic and discovered as incidental findings, there is a small number that can cause intracranial haemorrhage, usually attributed to associated cavernomas; however, venous thrombosis of the draining vein is a rare cause. A 10-year-old woman presented with seizure episodes. Angiographic evaluation revealed a collection of vessels draining into the superior sagittal sinus via the vein of Trolard, concerning for a DVA. The patient improved clinically with supportive care and antiepileptic treatment. Anatomically, DVAs represent dysplasia of primary capillary beds and smaller cerebral veins, resulting in abnormal venous drainage of the affected parenchyma. Several distinguishing radiological findings can help differentiate a DVA from other pathologies. Early radiological identification can help in the initiation of appropriate therapy and prevent incorrect surgical management leading to further neurological demise.
发育性静脉异常(DVAs)是最常见的脑畸形。虽然通常无症状,多为偶然发现,但仍有少数会导致颅内出血,通常归因于相关的海绵状血管瘤;然而,引流静脉的静脉血栓形成是一种罕见的原因。一名10岁女性出现癫痫发作。血管造影评估显示一组血管通过Trolard静脉汇入上矢状窦,怀疑为发育性静脉异常。患者经支持治疗和抗癫痫治疗后临床症状改善。从解剖学上讲,发育性静脉异常表现为原发性毛细血管床和较小脑静脉的发育异常,导致受影响实质的静脉引流异常。一些独特的影像学表现有助于将发育性静脉异常与其他病变区分开来。早期影像学识别有助于启动适当的治疗,并防止因错误的手术管理导致进一步的神经功能损害。