Developmental venous anomalies and cerebral cavernous malformations: Partners in crime

Figure 9 Cerebral cavernous malformation and developmental venous anomaly. A: Non-contrast-enhanced computed tomography in a 60-year-old man presenting to the emergency department due to dizziness and a medical history of arterial hypertension. A mildly hyperdense lesion was depicted in the right thalamus (dashed circle). Considering the location of the lesion and the medical history of arterial hypertension, it was suspicious of a hypertensive bleed. The lesion remained unchanged in follow-up computed tomography examinations, and therefore, further magnetic resonance imaging was decided; B: On T2-weighted images, the lesion displayed heterogeneous signal intensity centrally with a “popcorn-like” appearance and a peripheral low-signal hemosiderin rim; C: On T1-weighted images, heterogeneous, mostly hypointense, signal was noted centrally with mildly increased T1 signal in the periphery; D: On susceptibility-weighted imaging, the lesion displayed intense blooming. The findings were suggestive of a Zabramski type II cerebral cavernous malformation rather than a hypertensive bleed; E-G: This scenario was further validated by the depiction of an adjacent ectopic draining vein (arrows) on T1-weighted sagittal (E), coronal (F) and axial (G) maximum intensity projection reconstructions following intravenous gadolinium administration, thus indicating the concomitant presence of a developmental venous anomaly.