A 17-year-old girl presented with a 4-day history of severe left frontal headache, nausea, and vomiting that was worst in the morning. Neurological examination revealed an alert teenager with a right facial droop and no other focal neurological signs. Her medical history was significant only for occasional headaches and 1 year of oral contraceptive use.
Head computed tomography showed a small amount of hemorrhage, edema, and a probable thrombosed venous structure in the left frontal lobe (Figure 1A). Magnetic resonance imaging of the brain showed flow voids in the left frontal region consistent with a developmental venous anomaly (DVA), with surrounding edema (Figure 1B), scattered T2 hypointensity representing areas of hemorrhage, and weakly positive diffusion-weighted imaging consistent with a small hemorrhagic venous infarction. There was also significant edema and mass effect. Magnetic resonance angiography results were normal. Magnetic resonance venography showed a partially thrombosed deep vein draining the left frontal lobe. Thrombosis of the DVA and absence of other vascular malformations were confirmed by digital subtraction angiography. The partially occlusive clot within the venous collector of the DVA was well delineated on the sagittal view of the postcontrast magnetic resonance image and on the lateral projections of the angiogram (Figure 2).
Axial head computed tomography image and magnetic resonance image of the brain showing developmental venous anomaly thrombosis. A, Noncontrast head computed tomography image showing a thrombosed developmental venous anomaly (arrow) with hemorrhagic infarction in the left frontal lobe. B, Axial T2-weighted magnetic resonance image showing the typical appearance of a developmental venous anomaly in the left frontal region (arrow), with surrounding edema consistent with venous infarction.
Sagittal contrast-enhanced magnetic resonance image of the brain and digital subtraction angiography confirming developmental venous anomaly thrombosis. A, Sagittal magnetic resonance image showing an intraluminal defect consistent with partially occlusive thrombosis of the main developmental venous anomaly collector (arrows). B, Digital subtraction angiography confirming subocclusive thrombosis of the developmental venous anomaly collector (arrows) and delayed drainage with contrast stagnation in the developmental venous anomaly territory (caput medusae).
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