Developmental venous anomalies and cerebral cavernous malformations: Partners in crime

Figure 8 Cerebral cavernous malformation and developmental venous anomaly. A: Non-contrast computed tomography scan of a 40-year-old man presenting to the emergency department with an acute onset headache demonstrated a hyperdense-hemorrhagic lesion (dashed circle) in the right middle cerebellar peduncle, abutting the 4th ventricle; no contrast enhancement was shown. There was no relevant medical history or additional lesions; B and C: Magnetic resonance imaging examination performed a few days later demonstrates a central hyperintense signal intensity in T1-weighted images (B) and hyperintense signal centrally with a low signal hemosiderin rim on T2-weighted images (C), mild surrounding vasogenic edema was also noted on T2-weighted images. The findings were mostly suspicious of a Zabramski type I cerebral cavernous malformation with recent bleeding (T1 hyperintensity and mild surrounding vasogenic edema); D: On susceptibility-weighted images, intense lesion blooming due to hemosiderin was also noted. However, in addition, a concomitant developmental venous anomaly (evident by the caput medusae morphology) was detected in close vicinity to the lesion (dashed rectangle), thus adding further diagnostic confidence to a cerebral cavernous malformation as the underlying diagnosis for the hemorrhagic lesion.