Cerebral venous angioma of the pons complicated by nonhemorrhagic infarction

Case report

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✓ The authors emphasize an unusual complication of venous angiomas in the brain: venous infarction. The patient in this case is a 32-year-old man who presented with a clinical history of headache followed by a worsening of his neurological status. Neuroimaging studies demonstrated a brain infarct in the posterior fossa, which was related to thrombosis of the draining vein of a cerebral venous angioma. A conservative treatment approach without anticoagulation therapy was followed and the patient completely recovered. Nonhemorragic venous infarction caused by thrombosis of a venous angioma is exceptional and only nine previous cases have been reported in the literature.

Article Information

Address reprint requests to: Johann Peltier, M.D., Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens, Place Victor Pauchet, 80054 Amiens cedex 1, France. email: jojo.peltier@caramail.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left and Center: Unenhanced CT scans obtained at the level of the pons, demonstrating a tubular, high-density structure corresponding to the clot in the draining vein of the venous angioma. This malformation was located deep in the left middle cerebellar peduncle in the vicinity of the fourth ventricle. Right: Unenhanced CT scan obtained after the patient's condition had worsened, revealing a secondary obstructive hydrocephalus.

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    Axial T2-weighted MR images at the level of the pons exhibiting a high signal intensity corresponding to the nonhemorrhagic subcortical infarction of the vermis and left cerebellum. The tubular hypointensity and round shape correspond to the clot in the draining vein (arrows).

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    Axial three-dimensional spoiled gradient—recalled acquisition MR sequence revealing the venous angioma with its typical caput medusae appearance resulting from the convergence of small veins (arrowheads) on a large, thrombosed draining vein.

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    Axial T2-weighted MR images obtained at 1 month post-admission, demonstrating partial resolution of the cerebellar infarct and an area of high signal intensity related to an old clot in the draining vein (arrows).

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    Drawing of parasagittal section showing the location of the patient's venous angioma with its drainage vein (dv) and collector trunk (ct). Other main veins of the posterior fossa that could drain possible venous angiomas are also marked. Amv = anterior medullary vein; apmv = anterior pontomesencephalic vein; irtv = inferior retrotonsillar vein; ivv = inferior vermian vein; lbv = lateral brachial vein; pcev = precentral vein; pcuv = preculminate vein; psv = posterior spinal vein; pv = petrosal vein; srtv = superior retrotonsillar vein; svv = superior vermian vein; tpv = transverse pontine vein; vlr = vein of lateral recess of fourth ventricle.

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