A 32-year-old woman presented to the emergency department for evaluation of worsening headache that had lasted several weeks. She had a history of chronic headache and a remote history of vein of Galen aneurysmal malformation treated surgically in infancy, with additional endovascular occlusion of one of the feeders several years later (Figure 1). During her clinical course, she had also required a ventriculoperitoneal shunt for hydrocephalus. A computed tomographic scan demonstrated a large, peripherally calcified mass posterior to the third ventricle, representing the thrombosed vein of Galen aneurysm (Figure 2A). There was also ventricular enlargement and a ventricular catheter in the lateral ventricle (Figure 2B). Ventricular enlargement was stable when compared with previous scans. Her headaches were treated symptomatically as they were thought not to be related to shunt malfunction or any other shunt complications.
Left vertebral artery injection. A, There is filling of a giant venous varix. B, Nonsubtracted radiographs show peripheral calcification of the venous varix. C, Following coil embolization of an abnormally enlarged posterior choroidal artery feeder, there is no longer filling of the venous varix.
Computed tomography of the head's bone window (A) and soft-tissue windows (B). There is a large mass posterior to the third ventricle, consistent with the known vein of Galen aneurysmal malformation. There is dilation of the ventricular system with a ventricular catheter in place.
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