Idiopathic cerebellar hemorrhage in a patient with isolated developmental venous anomaly: A case report

Developmental venous anomalies (DVAs) are benign anatomical variations in venous angioarchitecture. They are considered low-flow malformations and are often incidental and clinically insignificant. Hemorrhagic complications from isolated DVAs are extremely rare, typically occurring due to coexisting cavernous malformation.

A 33-year-old female presented with severe headaches and vertigo, progressing from balance issues and dizziness. Misdiagnosed initially as Meniere's disease, her symptoms included left oculomotor nerve palsy, left-sided hemidysmetria, dysdiadochokinesis, and positive Romberg's sign. Cranial computed tomography revealed an acute hemorrhage in the cerebellar vermis. Contrast-enhanced magnetic resonance imaging and angiography identified an isolated DVA. The absence of substantial mass effect or obstructive hydrocephalus prompted conservative management with steroids and analgesics, leading to full recovery.

This case underscores the importance of considering isolated DVA in cerebellar hemorrhage etiology in young adults and conservative treatment is recommended to prevent secondary complications, given the DVA's role in normal venous drainage.