Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

OBJECTIVE: Cerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases. METHODS: From 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well. RESULTS: The mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively. CONCLUSION: Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

OBJECTIVE: Cerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases.METHODS: From 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well.RESULTS: The mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively.CONCLUSION: Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.

Angiomas venosos y cefalea en pediatría: un caso clínico / Venous angiomas and headache in children: A case report

Introducción: Los angiomas venosos (AV) son entidades benignas que infrecuentemente presentan síntomas. Objetivo: Reporte de un caso y revisión del tema. Caso clínico: Escolar, de sexo femenino, 6 años, que inicia cefaleas bifrontales frecuentes 3-4 veces por semana, en relación con trabajo académico, de carácter opresivo, no pulsátil, sin náuseas ni vómitos, rango de intensidad entre 4-6/10. Se inició manejo con calendario de cefaleas, apoyo escolar y evaluación psicológica. La tomografía computarizada cerebral solicitada informó de angioma venoso de núcleo caudado izquierdo, razón por la cual se realizó una resonancia magnética cerebral más angiorresonancia que confirmó angioma venoso y excluyó complicación o asociación a otra malformación vascular. La cefalea respondió bien a terapia psicopedagógica y psicológica. La frecuencia de cefaleas disminuyó a 10-12 al año, agrupadas en periodos de mayores demandas académicas. La paciente es controlada durante 12 años, hasta el egreso de la enseñanza media, sin complicaciones y con un buen manejo de la cefalea tensional. Conclusión: En el estudio de una cefalea el hallazgo de un AV puede ser incidental; una vez reunidos los criterios internacionales de cefalea tensional e iniciado el tratamiento para ello, la monitorización de los AV debe ser clínica. Las complicaciones del AV son infrecuentes y el tratamiento quirúrgico es excepcional.

Introduction: Venous angiomas (VA) are benign entities; however infrequent symptomatic cases may occur. Objective: Case report and literature review. Case report: A 6 year old girl was referred with a history of bi-frontal, non-pulsatile, headache with no nausea or vomiting. Headache intensity was 4-6/10. The episodes were frequent, 3-4 times per week. Triggers include academic work. Computed tomography showed a small VA in left caudate nucleus, which was confirmed by a brain MRI, with no evidence of inflammatory or ischaemic changes, or another vascular malformation. Psychological and psycho-pedagogic techniques were used, combined with relaxation and cognitive-behavioural techniques to reduce the intensity and frequency. There was a good outcome, and the headache decreased to 10 episodes per year. The patient was monitored for 12 years until graduation from high school. The VA remained without complications. Conclusions: In the study of a headache, a VA usually is an incidental finding. The International Classification of Headache Disorders III provides specific criteria of frequent episodic tension-type headache, and allows us begin specific therapy for it. Monitoring of non-symptomatic VA cases should be clinical. The surgical management of these entities is exceptional.

Venous angioma may be associated with epilepsy in children / 소아과

PURPOSE: Venous angioma (VA) is the most common congenital abnormality of the intracranial vasculature. This study aimed to investigate the relationship between VA and epilepsy and to identify the characteristics of children with VA and epilepsy. METHODS: The records of all patients aged less than 18 years who underwent brain magnetic resonance imaging (MRI) at Pusan National University Hospital were retrospectively reviewed. Patients with isolated VA and patients with normal MRI were compared in terms of the prevalence of epilepsy. RESULTS: In total, 2,385 pediatric patients who underwent brain MRI were enrolled. Isolated VA was identified in 26 patients (VA group). Among the patients with normal MRI findings, 225 age- and sex-matched patients to the VA-group were assigned to the control group. Nine patients in the VA group (9 of 26, 34.6%) and 27 patients in the control group (26 of 225, 11.5%; P<0.001) had epilepsy. In the VA group, 20 patients (76.9%) had the VA in the cerebral hemispheres, and 6 patients (23.1%) had the VA in the brainstem and cerebellum. The latter showed a higher prevalence of epilepsy (5 of 6, 83.3%) than the former (4 of 20, 20.0%; P=0.004). Among the nine patients who had epilepsy with VA, patients whose VA involved the brainstem and cerebellum showed a significantly higher frequency of abnormal Electroencephalographic findings than patients whose VA involved the cerebral hemispheres (P=0.016). CONCLUSION: VA, especially in the brainstem and cerebellum, might be associated with epilepsy.

Cerebral Venous Angioma Complicated by Non-hemorrhagic Venous Infarction

Venous angioma is normally asymptomatic, but it can present with clinical presentations such as seizures, headache, and focal neurological deficits. Brain hemorrhage is known to be the most common complication, with nonhemorrhagic brain infarction due to venous angioma being very rare. We report the first case of supratentorial venous angioma complicated by nonhemorrhagic venous infarction. This case occurred in a 49-year-old female, and was confirmed by magnetic resonance (MR) imaging including contrast-enhanced MR venography and perfusion imaging.

Cerebellar Venous Angioma Confused with Peripheral Vestibulopathy / 대한이비인후과학회지

Venous angioma is a congenital disease of vascular malformation, which is a mass like lesion consisted of dilated medullary veins. It is generally a silent lesion since it is found in normal brain tissues and tends to have low blood flow and pressure. The venous angioma could be diagnosed with magnetic resonance imaging and angiography, but most of them are incidentally diagnosed, because it is usually asymptomatic. The patients with venous angioma have nonspecific symptoms, such as headache, nausea and vomiting, seizures, progressive neurological deficit and hemorrhage. In particular, the venous angioma in cerebellum could cause hearing disturbance, tinnitus and dizziness. We report a case of venous angioma in cerebellum that had been mistaken for peripheral vestibulopathy in a patient complaining of dizziness

Giant Cavernous Malformation : A Case Report and Review of the Literature

Giant cavernous malformations (GCMs) occur very rarely and little has been reported about their clinical characteristics. The authors present a case of a 20-year-old woman with a GCM. She was referred due to two episodes of generalized seizure. Computed tomography and magnetic resonance image demonstrated a heterogeneous multi-cystic lesion of 7 x 5 x 5 cm size in the left frontal lobe and basal ganglia, and enhancing vascular structure abutting medial portion of the mass. These fingings suggested a diagnosis of GCM accompanying venous angioma. After left frontal craniotomy, transcortical approach was done. Total removal was accomplished and the postoperative course was uneventful. GCMs do not seem differ clinically, surgically or histopathologically from small cavernous angiomas, but imaging appearance of GCMs may be variable. The clinical, radiological feature and management of GCMs are described based on pertinent literature review.

A Case of Status Epilepticus Caused by a Venous Angioma of Brain / 대한소아신경학회지

Venous malformations has been shown to be the most common intracranial vascular malformation autopsy and clinical series. Cerebral venous malformation is associated with different frequnecies of epileptic seizures. Only in about 25% of cases are venous malformation diagnosed because of the occurrence of epileptic seizures. We report a case of 4 year-old female patient with status epilepticus caused by venous angioma in the right temporal lobe of the brain.

Cavernous Angioma Coexisting with Venous Angioma in the Posterior Fossa

Venous angioma and cavernous angioma have its own distinctive characteristics in the pathological, radiological, and clinical points of view. However, the chances of coexistence of two disease entities as the neuroimaging techniques developed, and highlight the possibility made us suspect that they might share the same pathogenesis. When they coexist, the clinical symptoms are almost always caused by cavernous angioma. Here, we report 2 cases of cavernous angioma coexisting with a venous angioma in the posterior fossa presenting acute brainstem dysfunction.

Clinical Characteristics of Angiographically Occult and Histologically Confirmed Intracranial Vascular Malformations

The medical records of 30 patients with histologically confirmed and angiographically occult intracranial vascular malformations(AOVM), who underwent surgery between May 1988 and May 1993, were reviewed retrospectively to determine whether their radiological and clinical characteristics are helpful in differential diagnosis. Histological diagnoses were cavernous angioma(CA) in 17 cases, arteriovenous malformation(AVM) in nine, venous angioma in one and unclassified vascular malformation in three. The most common initial presenting mode was intracranial hemorrhage(ICH ; 18 cases, 60.0%), followed by seizure(11 cases, 33.3%) and headache(two cases, 6.6%). CA, once it had bled, tended to bleed repeatedly, and this occurred before surgery in seven of nine cases of CA presenting with ICH. On CT scan, calcification was observed only in CA(two cases). On MRI images obtained in 28 patients, a mottled density mass with or without adjacent ICH(ten of 16 CA's) and multiple lesions(three of 16 CA's) were pathognomonic for CA, while single stage ICH(two of eight AVM's) and signal void(three of eight AVM's) were observed only in cases of AVM. Findings of MRI such as multiple stage hemorrhage, low signal intensity rim or edema around the lesion were not helpful in differential diagnosis of the histological type of lesions. After enhancement with gadolinium, one case of AVM and another of venous angioma showed a serpentine pattern of enhancement. In 29 cases, the results of surgery were excellent ; there was no mortality and morbidity in only one case. In conclusion, CA, once it had bled, tended to rebleed and MRI was helpful in the differential diagnosis of AOVM's. MRI findings such as a mottled density mass or multiple lesions were pathognomonic for CA, while single stage hemorrhage or signal void were findings of AVM.

Intracranial Venous Angioma with Arteriovenous Malformation: Case Report

Intracerebral venous angiomas with arterial components have been reported rarely. A case of venous angioma with arterial component is presented. The patient was a 29-year-old-female who presented with abrupt headache followed by left hemiparesis. Computerized tomography and magnetic resonance imaging revealed intracerebral hematoma in right temporoparietal lobe and basal ganglia with surrounding signal voids. The cerebral angiography showed the characteristic umbrella appearance and single large draining vein of venous angioma in right temporoparietal lobe and fine arterial branches supplying the vascular malformation. At the operation, multiple arteriovenous fistulas without nidus were observed and delicate angiomatous network with red veins were found around the hematoma cavity, Histologic examination of the angiomatous network proved it to be an arteriovenous malformation. It was a variant of mixed angioma, venous angioma combined with arteriovenous malformation. Clinical, angiographic, and pathological features of intracerebral venous angiomas with arterial components were reviewed from literatures.

A Study of Venous Angiomas

The clinical significance of venous angiomas is controversial. Owing to the increased resolution of modern CT scannes and the advent of magnetic resonance imaging(MRI) as well as an increased awareness of these lesions, venous angiomas has been recognized more frequently in routine neuroradiographic examinations. In a retrospective study of 1998 brain MR imaging performed at our institute between April, 1990 and April, 1992, 18 cases of venous angioma were diagnosed. Among them, 13 cases(72.2%) occur supratentorially and 5 cases(27.8%) occur in cerebellum. Their symptoms were headache(7 cases), hemorrhage(4 cases) seizure(3 cases), focal neurological sign(1 case) and no associated symptoms(3 cases). All cases have been managed conservatibely except one case(with massive cerebellar hemorrhage). During follow up period, no significant complications was happened in all cases. Long-term follow up is necessary to develop meaningful recommendations regarding the management of venous angiomas.

A Case of Cerebellar Venous Angioma Associated with Huge Intracranial Arteriovenous Malformation

A case of cerebellar venous angioma incidentally associated with huge intracranial arteriovenous malformation is reported. This 50-year-old male patient was admitted presenting symptoms of subrachnoid hemorrhage. Brain CT and cerebral angiography showed huge AVM in the right parieto-occipital area and also right cerebellar venous angioma draining into the straight sinus. No clinical manifestation was correlated to this venous angioma and no specific treatment was made to this lesion. The AVM was removed totally and the patients is now in follow-up evaluation through OPD with slight left hemiparesis.