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We report the case of a 19-year-old male who presented with his first-ever epileptic seizure (bilateral tonic-clonic). Clinical examination on admission only showed a lateral tongue bite. The medical history consisted of a Borderline personality disorder and a treated hypothyroidism. Neuroradiological examination with CT- and MRI-scans including CT- and MRI-Angiography showed a large Developmental Venous Anomaly (DVA) in the left temporal lobe. Its collecting vein, draining into the superficial venous system was almost totally occluded by an acute thrombosis, resulting in venous congestion, surrounding parenchymal and epidural hemorrhage and venous ischemic infarction. No associated vascular malformations or other brain parenchymal abnormalities were found.

DVAs are largely accepted to form during intrauterine life, either as anatomical variations, or due to thrombosis of normal parenchymal veins. They are frequently encountered on routine diagnostic imaging, especially on MRI scans. DVAs can be associated with one or more regional cavernous malformation, which is thought to be the reason for the vast majority of symptomatic cases. Hemorrhagic or ischemic infarction around a DVA may result from acute thrombosis of the collecting as in our case. Recent reviews of literature and retrospective analyses of case reports on symptomatic DVAs prove this to be a rare phenomenon.

Considering pathophysiological similarities with venous/sinus thrombosis and case reports in the literature, we decided to treat the patient with oral anticoagulation for at least six months. Anti-convulsive medication was given. A laboratory investigation of prothrombotic/procoagulatory conditions was carried out with negative results.
So far the patient is doing well without further seizures and focal neurologic signs. Follow-up clinical examination and imaging will be conducted.