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Images in Neurology |

Deep Venous Anomaly Caput Medusa in the Brain

Andreas K. Demetriades, MBBChir, MPhil, MRCS(Edin), MRCS(Eng); John S. Norris, FRCS(SN)
Arch Neurol. 2009;66(11):1421. doi:10.1001/archneurol.2009.238.
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A 24-year-old man presented with a left facial partial seizure. He had no neurological deficit. Brain magnetic resonance imaging showed a possible vascular malformation in the deep right frontal semiovale white matter, a serpiginous structure extending toward the medial right convexity, demonstrating a flow void on T2 images. There was no parenchymal or extraaxial hemorrhage.

Digital subtraction angiography revealed a large developmental venous anomaly (DVA) in the paramedian right midfrontal lobe, draining the deep white matter via 2 transcortical veins toward the anterior superior sagittal sinus, that resembled a caput medusae.

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Figure.

Magnetic resonance imaging and digital subtraction angiography. A, T2-weighted brain magnetic resonance image shows a serpiginous structure (arrow) demonstrating a flow void in the deep right frontal semiovale white matter, but no suggestion of a cavernoma. B, Digital subtraction angiography shows a large developmental venous anomaly in the paramedian right midfrontal lobe (white arrow), draining the deep white matter via 2 transcortical veins toward the anterior superior sagittal sinus, that resembles a caput medusae. Venous drainage of the right hemisphere is via a large vein of Labbé (black arrow) that collects the superficial sylvian territory and anastomoses with an anterior subfrontal vein. C, The caput medusa, a cluster of veins resembling a head of snakes, drains into a larger collector vein that usually is on the surface of the brain.

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