Coexistence of cerebral cavernous malformations (CMs) and developmental venous anomaly
(DVA) represents the most common form of mixed intracranial vascular malformations.
Existing literature supports not only a possible causative role of DVA for de novo
CMs but also a potentially detrimental effect on an associated CM, increasing the
chances of hemorrhagic complications and growth in the latter. A 52-year-old gentleman
presented to us with a 17-year long history of simple motor seizures on the left faciobrachial
region. On magnetic resonance imaging (MRI) of the head, a 1.5 cm × 1.5 cm CM without
any evidence of recent hemorrhage was identified in the left high frontal premotor
area. There was a linear enhancement in the adjoining superior frontal sulcus on contrast
MRI. On intra-arterial angiogram, this hyperintensity was confirmed to be a venous
channel draining into the superior sagittal sinus. Thus, a diagnosis of cavernoma
associated with a DVA was made. The patient was advised conservative treatment and
he was doing well at follow-up. Unless diligently looked for, DVA associated with
CM may be easily missed. The coexistence has pathophysiological and management implications.
Despite the reported aggressive natural history, there is a scope for conservative
treatment for these complex vascular malformations.
Key-words:
Angiography - cavernous malformation - conservative - developmental venous anomaly
- hemorrhage - venous angioma
