PMC3253395_01
18-year-old male with atypical developmental venous anomaly.. A. Initial precontrast brain CT image showing large intracerebral hemorrhage in right parietal lobe and intraventricular hemorrhage in bilateral lateral ventricles. B. Right internal carotid angiogram of lateral image showing arterial pedicle (arrows) from pericallosal branch of right anterior cerebral artery. C. Late arterial phase angiogram showing early venous drainage (arrow). D. Developmental venous anomaly visualized in right parietal lobe in venous phase. E-G. Serial microangiogram clearly demonstrating arterial pedicle (arrowheads), site of arteriovenous fistula (large arrow) and early venous drainage (small arrows). Venous drainage from arteriovenous fistula shares venous channel of developmental venous anomaly showed in D and tip of microcatheter (open arrow) is also seen. H. Cast of NBCA-Lipiodol is located in distal arterial pedicle (arrowhead), arteriovenous fistula (large arrow), and venous channel just distal to arteriovenous fistula (small arrow). I, J. Late arterial phase lateral projection image (I) showing delayed flow in pedicle along with no arteriovenous shunt in post-embolization angiogram. Developmental venous anomaly still persists in venous phase (J) after embolization.
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The CT revealed severe ICH with surrounding brain edema in the right parietal lobe and IVH in the bilateral lateral, 3rd and 4th ventricles (Fig. 1A). Allura; Philips Medical Systems, Best, The Netherlands) to highlight a prominent distal parietal branch of the pericallosal artery of the right anterior cerebral artery; in the late arterial phase, dilated medullary veins and caput medusae appearance of a DVA were seen. A venous phase angiogram showed a similar DVA (Fig. 1B-D). The superselective angiography clearly showed a single arterial feeder from the dilated distal parietal branch of the right pericallosal artery, and a single AVF; this fistula shared the DVA-like venous channel (Fig. 1E-G). AVS (Fig. 1H). After glue embolization of the AVF, early venous drainage disappeared and DVA was visualized only in the venous phase during control angiography (Fig. 1I, J).