Developmental venous anomalies (DVA) are normally diminutive and incidental.1,2 In this 33-year-old patient with epilepsy, the DVA is holohemispheric. Her epilepsy probably originates from the left side based on semiology; the EEG displayed left-sided slowing. Axial T1-weighted sequences show skull atrophy, ventricular widening, and satellite cavernous malformations with accumulation of subacute blood products including hemosiderin (figure, A and B). T2 gradient echo illustrates pockets of chronic hemorrhage (figure, C and D). Engorged holohemispheric anomalous venous structures channel into ventricular periependymal veins, illustrated by mulitplanar T1 echo spin postcontrast sequences (figure, E and F). Time to minimum perfusion reflects elevated transit times, suggesting venous hypertension and capillary backpressures.
(A, B) Precontrast axial T1-weighted images. (C, D) Axial T2* gradient echo. (E, F) Postcontrast axial T1 spin echo. (G, H) Axial time to minimum perfusion map. (I) Postcontrast axial gradient echo T1 coronal.
Footnotes
Author contributions: A.K. Jung: drafting of manuscript, data collection. Dr. Henson: data collection, imaging review. Dr. Susanto: drafting of manuscript, imaging review. Dr. Caylor: drafting of manuscript, data collection. Dr. Doherty: manuscript coordination and drafting.
Study funding: No targeted funding reported.
Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
- © 2013 American Academy of Neurology
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