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Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1

This 36 year old female had an initial CT examination for headache without other neurological signs, revealing a small calcified lesion in the brain stem. Subsequent MRI showed signal anomalies compatible with a cavernous angioma and an associated DVA. The latter was confirmed by MRA.

(Brain stem DVA, 0.5T)
Fig.1 Sagittal non-enhanced and Gadolinium-enhanced T1-weighted spin-echo images. Small punctate hypointense area at the level of the ponto-mesencephalic junction, exhibiting enhancement after intravenous Gadolinium injection.
Fig.2 Transverse proton density and T2-weighted fast spin-echo images at the level of the mesencephalon. Patchy signal inhomogeneities in the tegmentum and a slightly oblique, linear, signal void structure in the ventral part of the mesencephalon.
Fig. 3 Coronal T2-weighted gradient-echo and corresponding T1-weighted Gadolinium-enhanced spin-echo images. Marked enhancement of the transmesencephalic DVA and very faint increase of signal from the presumed associated cavernous angioma, which appears to be hypointense on gradient-echo images (hemosiderin deposits?).
Fig. 4 Transverse Gadolinium-enhanced T1-weighted thin sections of the mesencephalon from a 3D acquisition. The extramesencephalic draining vein of the DVA (arrows) runs towards the left cavernous sinus- inferior petrosal sinus junction.
Fig. 5 Transverse source images from a Gadolinium-enhanced 3D TOF MRA sequence. Identical findings as in Fig. 4.
Fig. 6 Sagittal and transverse targeted MIP reconstructions of the Gadolinium-enhanced 3D TOF sequence. The previously non-visualized caput medusae component of the DVA becomes more apparent in the posterior part of the pons on the sagittal reconstruction. Drainage towards the inferior petrosal sinus is also better appreciated.
NB. Although suspected, the presence of the topographically associated cavernous angioma has never been proved, as this patient did not undergo surgery.

 

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Fig. 1

Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1, Fig. 1
Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1, Fig. 2
Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1, Fig. 3
Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1, Fig. 4
Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1, Fig. 5
Brainstem development venous anomaly (DVA) and a suspected topographically associated cavernous anoma, case 1, Fig. 6