Ahmed Manzoor, AlMarzooqi Mohamed-Karji, Younes Basel Mahmoud, Alokaili Riyadh Nasser, Azam Farooq
Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE.
Department of Neurosurgery, Sheikh Khalifa Medical City, Abu Dhabi, UAE.
Neurol Sci. 2020 Aug;41(8):2147-2155. doi: 10.1007/s10072-020-04294-9. Epub 2020 Mar 4.
We aim to present here a small case series of symptomatic isolated hemorrhagic arterialized developmental venous anomalies (sDVAs) with a larger goal of revisiting the classification based on patho-mechanisms plus emphasizing angiographic features coupled with CT and MRI. Typically, DVA is an incidental and silent abnormality on neuroimaging. Understanding its morphology in terms of arterialization and relationship with other entities is crucial for management. One adult and two pediatric cases presented with acute or sub-acute hemorrhage in the cerebellum or thalamus. Morphologic characterization on cross-sectional imaging and catheter angiography confirmed the integrated diagnosis of "symptomatic isolated hemorrhagic arterialized DVAs with deeper or superficial venous drainage". Conservative management was adopted in all cases. We emphasize the following classification and approach for symptomatic DVAs: (1) congestive isolated arterialized sDVAs, (2) congestive isolated resistive sDVAs, (3) coexisting sDVAs (with AVM or cavernous malformation), (4) compressive sDVAs (compressive effects), and (5) idiopathic DVAs. Like our three cases, ganglionic and infratentorial DVAs have higher propensity of hemorrhage, compressive effects, and usually harbor deeper venous drainage. Typical "caput medusae" as dominant collector vein on cross-sectional imaging is crucial to complement and even confirm the diagnosis of DVA before catheter angiography in sDVAs. Capillary stain or early opacification of DVAs is a marker of arteriovenous shunting in arterialized sDVAs. Recognition of this entity is crucial as treatment is usually conservative.
我们旨在在此展示一个症状性孤立性出血性动脉化发育性静脉异常（sDVA）的小病例系列，其更大目标是重新审视基于病理机制的分类，同时强调血管造影特征以及CT和MRI表现。通常，DVA在神经影像学上是一种偶然且无症状的异常。从动脉化角度理解其形态以及与其他病变的关系对于治疗至关重要。1例成人和2例儿童病例表现为小脑或丘脑的急性或亚急性出血。横断面成像和导管血管造影的形态学特征证实了“具有深部或浅部静脉引流的症状性孤立性出血性动脉化DVA”的综合诊断。所有病例均采用保守治疗。我们强调以下针对症状性DVA的分类和方法：（1）充血性孤立性动脉化sDVA，（2）充血性孤立性阻力性sDVA，（3）共存性sDVA（伴动静脉畸形或海绵状畸形），（4）压迫性sDVA（压迫效应），以及（5）特发性DVA。与我们的3例病例一样，神经节性和幕下DVA出血倾向更高、具有压迫效应，且通常伴有深部静脉引流。在sDVA中，横断面成像上典型的“水母头”作为主要引流静脉对于在导管血管造影前补充甚至确诊DVA至关重要。DVA的毛细血管染色或早期显影是动脉化sDVA中动静脉分流的标志。认识到这一实体至关重要，因为治疗通常是保守的。
