Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 56, Num. 1, 2008, pp. 104-105

Neurology India, Vol. 56, No. 1, January-March, 2008, pp. 104-105

Neuroimage

Susceptibility weighted imaging in holohemispheric venous angioma with cerebral hemiatrophy

Somasundaram Sivaraman, Kesavadas Chandrasekharan, Thomas Bejoy

Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala
Correspondence Address:Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala, chandkesav@yahoo.com

Date of Acceptance: 21-Jan-2007

Code Number: ni08034

A 13-year-old boy presented with history of recurrent episodes of right focal seizures since first year of life. The neurological examination was within normal limits. Routine laboratory and hematological workup was also normal. The seizures were well controlled on anti-epileptic medication.

Plain computerized tomography (CT) of the head revealed calcification in the left frontal region [Figure - 1]A. Post-contrast CT revealed a large venous angioma with multiple linear enhancing vessels in the left centrum semiovale draining into a common collector/draining vein, seen adjacent to the body of the left lateral ventricle [Figure - 1]B. Digital subtraction angiogram (DSA) was performed for better delineation of the lesion and to exclude any possibility of arteriovenous malformation. Angiogram revealed the classical medusa head appearance of the venous angioma [Figure - 1]C.

Magnetic resonance imaging done on a 1.5 Tesla MRI scanner during a recent follow-up, showed the linear hypointense flow void adjacent to the left lateral ventricle in conventional sequences [Figure - 2]A-C. The extensive nature of the lesion could not be demonstrated. Susceptibility weighted imaging (SWI) revealed the extensive holohemispheric nature of the venous angioma with excellent depiction of the transmedullary veins draining into the collector vein [Figure - 2]D,E. The hemi atrophy of the left cerebral hemisphere was also appreciated.

Susceptibility weighted imaging consists of using both magnitude and phase images from a high-resolution, three-dimensional, fully velocity-compensated gradient echo sequence. ^[1] Developmental venous anomalies (venous angiomas) are low-flow vascular malformations, which are usually less conspicuous in conventional non-contrast MR images. Susceptibility weighted imaging is ideal for screening patients with a high clinical suspicion of low-flow vascular malformations ^[2] and limits the use of contrast studies and digital subtraction angiograms in their demonstration.

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