Symptomatic Developmental Venous Anomaly Thrombosis : Can Anticoagulants Be Given ?

Background and Aims:Background :Developmental venous anomalies (DVA )are brain vascular malformations - autopsy incidence ~ 2.6%; magnetic resonance imaging (MRI) detection rate 0.48u20130.7%. Symptomatic DVAs are rare; < 35 patients with spontaneous DVA thrombosis (DVAT) have been reported till date, several of whom had associated parenchymal hemorrhage. Aim: To describe a rare case of symptomatic, spontaneous DVAT managed with anticoagulation.Methods: Case descriptionResults:35 year male presented with one day of left upper limb (LUL) weakness, headache. Neurological exam showed LUL monoparesis. Brain Imaging in Emergency department showed right, partially thrombosed (saccular component) frontal DVA with drainage into deep ependymal vein and superior sagittal sinus (Fig 1; Left panel). No associated bleed or venous infarct noted. Therapeutic dose Clexane was initiated. He had 3 episodes generalized seizures; subsequent MRI showed thrombosis progression and localized FLAIR hyperintensity surrounding the thrombosed DVA (Fig; Middle Panel). Epilim was given , Laboratory tests for inherited and acquired procoagulant states were negative; Clexane was continued. 4Vessel angiogram, 6 weeks later, showed partial recanalization only. Neurosurgeons opined conservative management. Clexane was continued. Evaluation at 12 weeks showed no focal deficits. There were no hemorrhagic complications. Switch to oral anticoagulation was planned but patient was subsequently lost to follow-up.Conclusions:Symptomatic, spontaneous DVAT is very rare. There are no guidelines regarding management. DVA resection is avoided so as to prevent catastrophic venous infarction. Anticoagulation appears safe, but duration is debatable in absence of known procoagulant states.