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Isolated hemorrhagic arterialized DVAs: revisiting symptomatic DVAs.
Manzoor Ahmed1, Mohamed-Karji AlMarzooqi2, Basel Mahmoud Younes3
1Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE. manahmed@seha.ae.
Summary
Symptomatic isolated arterialized developmental venous anomalies (sDVAs) can cause hemorrhage. This case series revisits DVA classification, emphasizing imaging features and conservative management for these rare, symptomatic cases.
Area of Science:
- Neuroradiology
- Vascular Malformations
- Neurointerventional Radiology
Background:
- Developmental venous anomalies (DVAs) are typically incidental findings.
- Symptomatic DVAs, particularly arterialized forms, require careful characterization.
- Hemorrhage is a known complication of certain DVAs.
Purpose of the Study:
- To present a case series of symptomatic isolated hemorrhagic arterialized DVAs.
- To revisit DVA classification based on patho-mechanisms.
- To emphasize key angiographic, CT, and MRI features.
Main Methods:
- Case series of three patients (one adult, two pediatric) with symptomatic DVAs.
- Morphologic characterization using cross-sectional imaging (CT/MRI) and catheter angiography.
- Review and proposed classification of symptomatic DVAs.
Main Results:
- All three cases presented with acute/sub-acute hemorrhage (cerebellum/thalamus).
- Diagnosis confirmed as "symptomatic isolated hemorrhagic arterialized DVAs with deeper or superficial venous drainage".
- Ganglionic and infratentorial DVAs showed higher hemorrhage and compressive propensity.
Conclusions:
- Conservative management was adopted for all presented cases.
- A proposed classification for symptomatic DVAs includes congestive, coexisting, compressive, and idiopathic types.
- Recognition of arterialized DVAs is crucial due to their propensity for hemorrhage and typically conservative treatment.
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