Cerebral Venous Malformation Associated with a Varix and Abnormal Signal in Surrounding Brain Parenchyma on Magnetic Res
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Correspondence
Cerebral Venous Malformation Associated with a Varix and Abnormal Signal in Surrounding Brain Parenchyma on Magnetic Resonance Imaging: A Case Report R. Nakajima · A. Uchino · S. Sakai
Received: 1 June 2012 / Accepted: 1 September 2012 / Published online: 1 October 2012 © Springer-Verlag 2012
Introduction Cerebral ‘venous malformation’ or ‘developmental venous anomaly’ is a relatively common vascular malformation found incidentally on magnetic resonance (MR) imaging, may be associated with other vascular malformations— most frequently, cavernous malformation (13–40 %) [1, 2], and occurs rarely with varices [3–8]. We present a case of venous malformation with associated varix and hyperintensity of surrounding brain parenchyma that was identified on fluid-attenuated inversion recovery (FLAIR) image. We believe that increased blood pressure in the draining vein may have caused the varix and increased signal intensity. Though abnormality of signal intensity on T2-weighted or FLAIR images in the drainage territory of venous malformations is reported, we believe ours is the first case of venous malformation with associated varix and hyperintense surrounding brain parenchyma diagnosed by MR imaging. Case Report A 74-year-old woman who was treated 9 years earlier for left breast cancer visited a local hospital for lumbago and underwent nonenhanced brain and spine computed tomography (CT) as screening for metastatic lesions. The nonR. Nakajima, MD () · S. Sakai, MD, PhD Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho Shinjuku-ku, 162-8666 Tokyo, Japan e-mail: [email protected]
enhanced brain CT showed spotty hyperdensity in the left frontoparietal lobes and degenerative lesions in the lumbar spine. The woman was admitted to our hospital for suspected brain tumor metastasis or hemorrhage. Her history included no significant illness other than the left breast cancer, and blood, neurologic, and other systemic examination findings were normal. She underwent pre- and postcontrast brain CT scans. The precontrast CT showed spotty hyperdensity with surrounding hypodensity in the left frontoparietal lobes (Fig. 1). Postcontrast CT revealed linear enhancing structures in the left frontoparietal lobes, and dilated veins continued to a dilating vascular structure, probably a varix (not shown). MR imaging at 1.5 T showed a lesion isointense to the gray matter on T1-weighted (Fig. 2a) and hyperintense on FLAIR (Fig. 2b) images. The central linear structure enhanced intensely after gadolinium administration (Fig. 3). The coronal image showed mild stenosis in the distal part of the draining vein. The maximum intensity projection (MIP) image obtained from postcontrast 3-dimensional (3D) images clearly demonstrated the entire structure of the vascular lesion (Fig. 4). We could not identify hemorrhagic signal on a T2*-weighted image (not shown). The surrounding parenchyma was hyperintense on FLAIR image. Based on these findings, we diagnosed venous malforma
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