PMC10070300_01
Imaging findings on admission (a and b) CT shows a slight high-density area in the left occipital lobe (arrow), which is hypointense on T2 star weighted image of MRI (arrow). (c) T2-weighted image of MRI shows flow voids around the cerebellum and brainstem (arrows). (d) MRA clearly visualizes the IJV and sigmoid sinus (arrow), and venous reflux into the anterior condylar vein and cavernous sinus can also be confirmed. CT: Computed tomography, MRI: Magnetic resonance imaging, MRA: Magnetic resonance angiography, IJV: Internal jugular vein.
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F1
T2 star weighted image of magnetic resonance imaging (MRI), and was diagnosed with subcortical hemorrhage [Figures 1a and b]. T2-weighted image showed flow voids in the cerebellar hemispheres, left occipital lobe, left parietal lobe, and around the brainstem [Figure 1c]. Magnetic resonance angiography (MRA) showed abnormal signals in internal jugular vein (IJV), sigmoid sinus, transverse sinus, inferior petrosal sinus, anterior condylar vein, and cavernous sinus such as dural AVF(dAVF) [Figure 1d].
Left common carotid angiography (a) Venous perfusion of the left cerebral hemisphere uses the right transverse sinus (arrow), and the left transverse sinus is not visualized. (b and c) The venous blood flow of the left cerebral hemisphere reflux into cortical veins (arrow). Venous stasis and venous perfusion failure are detected (arrowheads).
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F2
DSA showed that the blood flow in the left cerebral hemisphere was mainly perfused through the right transverse sinus contralaterally [Figure 2a], but partially refluxed into cortical veins such as the vein of Trolard, leading to venous stasis and venous perfusion failure [Figures 2b and c].
Venography through the arteriovenous graft (a) The left BCV is occluded (arrowhead) and veins flow back into the IJV (arrow), (b) Undergoing PTA for the left obstructive BCV (arrow), (c) The stenosis of the left BCV is only slightly improved (arrowhead). But reflux into the IJV remains and the ectasia of the subcutaneous veins in the left upper arm and neck is observed (arrow). BCV: Brachiocephalic vein, IJV: Internal jugular vein, PTA: Percutaneous transluminal angioplasty.
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F3
Venography showed occlusion of the left BCV and IVR through the IJV [Figure 3a]. Percutaneous transluminal angioplasty (PTA) for the left obstructive BCV was performed, but the obstructive lesion was only slightly improved [Figures 3b and c].
MRI on the day after shunt LIGATION Abnormal signals in the IJV completely disappear (arrow). MRI: Magnetic resonance imaging, IJV: Internal jugular vein.
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F4
MRI on the day after surgery showed complete disappearance of venous reflux [Figure 4].