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).
Thank you for submitting a comment on this article. It will be reviewed by JAMA Neurology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
Users' Guides to the Medical Literature
Example of a Decision Tree
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.