Medusa-like Atypical Intracerebral Vein: A Rare Case of Symptomatic Developmental Venous Anomaly

Abstract

Developmental venous anomaly (DVA) is an extreme variation of the normal transmedullary vein, which is necessary for the normal venous drainage of an area of the brain. It occurs in as many as 2% of individuals. In most cases, it is considered to be an incidental finding, however it can be symptomatic under very rare circumstances. The possible pathomechanism of symptomatic DVA is broadly divided into mechanical and flow-related. The flow-related pathomechanism accounts for the majority of cases. Susceptibility weighted magnetic resonance imaging study is the imaging modality of choice in all vascular anomalies because it can detect even very remote vascular abnormalities and its superiority over conventional imaging can never be over emphasized. Irrespective of the pathomechanism of DVA, conservative management remains the treatment of choice. This case of symptomatic DVA is presented to buttress the fact that though most symptomatic venous anomalies are associated with hemorrhage from cavernoma, in rare cases, symptoms may arise from DVAs that are not associated with other vascular malformations.