DVA, Unruptured
H&P
- HPI:
- Presented to ED
- Headache and photophobia
- PE: GCS 15, no gross deficits
- Workup: CT head w/o contrast, brain MRI with and without contrast
Imaging
CT Head without Contrast - Axial, Coronal, and Sagittal
Left medial frontal lobe hypodensity, corresponding to the history of ICH 2 weeks ago.
Brain MRI - DWI/ADC/FLAIR/SWI
Brain MRI - T1WI, T2WI, T1WI with Contrast
Brain MRI - T2WI, T1WI with Contrast, SWI
A developmental venous anomaly is seen at the interhemispheric location, adjacent to the genu of the corpus callosum.
Serial Axial T2WI
The DVA appears to drain inferiorly into the internal cerebral vein.
Diagnostic Cerebral Angiography
- Access: right common femoral artery
- 5F 10 cm sheath
- 4F 100 cm Glidecath
- 0.035‘’ 180 cm Glidewire
DSA - Left ICA, PA and Lateral
DSA - Left ECA, PA and Lateral
Brain MRI and DSA (Right ICA Injection) - T2WI, PA (Late Arterial Phase, Early Venous Phase, and Late Venous Phase)
Interpretation of the DSA
- No vascular lesion is identified to explain the medial left frontal lobe hemorrhage
- The DVA can be seen in the venous phase
Discussion
- Developmental venous anomaly
- RCVS remains a possible cause of the ICH