CASE 17170 Published on 22.03.2021

Developmental Venous Anomaly with Dystrophic Calcification in the left basal ganglia.

Section

Neuroradiology

Case Type

Clinical Cases

Authors

Sofie Van Cauter1,2, Brecht Van Berkel1,2

1. Department of Radiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium

2. Department of Radiology, UZ Leuven, Herestraat 49, 3000 Leuven

 

Patient

53 years, male

Categories
Area of Interest Neuroradiology brain ; Imaging Technique MR
Clinical History

A patient with obstructive sleep apnoea syndrome presented with recurring episodes of headache, concentration difficulties and drowsiness. An MRI was performed following a low-dose CT of the sinuses that showed large dystrophic calcifications in the left basal ganglia.

Imaging Findings

The initial CT-scan was a low dose scan of the maxillofacial region and only part of the brain parenchyma was visualised. The CT-scan showed large dystrophic calcifications in the left basal ganglia without mass effect (Fig. 1). A subsequent MRI showed hypointense signal changes of the left basal ganglia on T1-weighted images (T1WI) (Fig. 2), T2-weighted-Fluid-Attenuated Inversion Recovery (FLAIR) (Fig. 3) and Susceptibility weighted imaging (SWI) (Fig. 4). These signal changes were especially notable at the caudate nucleus and the anterior part of the putamen and were compatible with calcifications. No lesions with diffusion restriction were visualised.

On FLAIR (Fig. 5a and 5b), SWI (Fig. 6a and 6b) and T1WI with gadolinium (Fig. 7a and 7b) a venous anomaly was visible with small veins at the left basal ganglia converging in a larger anomalous vein. This venous anomaly was best visible on SWI and T1WI with gadolinium.

Discussion

Developmental venous anomalies (DVA) are the most common cerebral vascular malformation. On routine MRIs, approximately 7.46% of Caucasians have DVAs and a negative relationship with age has been mentioned [1]. DVAs are regarded as benign anatomical variants, no treatment is necessary as surgical removal can cause venous infarction and ischaemia [2]. Cavernous malformations are reported more frequently in patients with DVAs [3]. These cavernous malformations can cause cerebral haemorrhage and they can require surgical removal with preservation of the DVA [4].

In patients with DVAs, a pattern of calcifications in the basal ganglia was observed, involving almost exclusively the caudate and the anterior putamen [5]. This pattern occurs in approximately 9.6% of patients [6]. FLAIR hyperintense signal changes have also been reported in a small percentage of patients with DVAs [1,7]. In general, DVAs are most easily seen on T1WI with contrast or SWI images. 

In conclusion, unilateral calcification of the basal ganglia, without mass effect can be caused by a DVA, a benign finding that requires no treatment.

Differential Diagnosis List
Developmental venous anomaly with dystrophic calcification in the left basal ganglia
Prior unilateral injury: infection of neoplasm
Primary Familial Brain Calcification
Non-ketotic hyperglycemic hemichorea-hemiballismus
Final Diagnosis
Developmental venous anomaly with dystrophic calcification in the left basal ganglia
Case information
URL: https://www.eurorad.org/case/17170
DOI: 10.35100/eurorad/case.17170
ISSN: 1563-4086
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