Multimodal Imaging Follow-up of a Thrombosed Developmental Venous Anomaly: CT, CT Angiography and Digital Subtraction Angiography
A 31-year-old male presented with loss of consciousness of abrupt onset after several days of headache. Initial pre-contrast CT showed swollen hypodense area, ICHs and linear hyperdensity in the left frontal lobe (). CT angiography with 3-dimensional post processing revealed dilated medullary veins with caput medusa appearance, but no venous drainage from the left frontal DVA) (). Multiplanar source images of CT angiography demonstrated the filling defect in the anterior superior sagittal venous sinus and suggested the thrombosis in the draining vein (). On follow-up CT angiograms ten days (not shown in this report) and two months later (), thrombosed draining vein was progressively recanalized and detected were findings of venous infarction with multifocal parenchymal hemorrhages in the left frontal lobe. Repeated digital subtraction angiography two years after the initial clinical presentation () clearly showed the presence of resolving venous thrombosis at a month ().\nNo underlying cause such as connective tissue disease, coagulopathy, history of steroid administration, dehydration and so on was identified for the spontaneous thrombosis in the venous drainage from DVA.\nThe patient was treated conservatively, became conscious five days later and eventually recovered without localized neurological deficit. He developed generalized seizure, but had been under control with anti-epileptic medications.