Developmental Venous Anomaly Presenting as an Acute Stroke Mimic

Area of Science:

• Neurology
• Radiology
• Vascular Malformations

Background:

• Acute ischemic stroke diagnosis can be challenging due to conditions mimicking its presentation.
• Intravenous thrombolysis is a time-sensitive treatment for acute ischemic stroke.
• Developmental venous anomalies (DVA) are common cerebral vascular variants that can present with focal neurological deficits.

Observation:

• A case is presented where a patient exhibited acute focal neurological deficits and CT scan hypodensities.
• These findings created a diagnostic dilemma regarding the administration of intravenous tissue-type plasminogen activator (IV tPA).
• Subtle CT brain changes inconsistent with acute ischemic stroke prompted further investigation.

Findings:

• The patient's presentation was ultimately diagnosed as a Developmental Venous Anomaly (DVA).
• This case highlights the importance of considering DVAs in the differential diagnosis of stroke mimics.
• Accurate identification of DVAs prevents unnecessary or inappropriate thrombolytic therapy.

Implications:

• Clinicians must be vigilant in recognizing imaging features that differentiate DVAs from acute ischemic stroke.
• Consideration of DVAs can prevent complications associated with incorrect thrombolysis administration.
• Enhanced diagnostic accuracy for stroke mimics improves patient outcomes and optimizes resource allocation.