Venous Angiomas and Its Symptoms

Q: Follow up case. Continued from Causes of calcified granuloma in brain.

(MRI – Brain + MRV) Report

There is small abnormal signal intensity lesion, measuring 1.2*0.6 cm in size seen in posterior aspect of right inferior temporal gyrus.

On T1W sequence, there are high signal intensity foci seen within the lesion. On T2 high signal foci are seen within the lesion. Also seen few dilated veins converging centrally. The lesion represents the appearance of an umbrella. On MRV, there appears to be abnormal vein draining towards the lesion. No evidence of thrombosis of major venous sinuses. No similar lesions area seen in the rest of the brain. No other abnormal signal intensity lesions are seen in the cerebral  hemisphere, cerebellum or brain stem. The ventricular system is normal. No mid line shift. Corpus callosum and gland are normal. Both orbits are normal. Bilateral maxillary sinus are unremarkable. Incidentally chonca ballosa is seen on right side.

Impression:

Features are suggestive of a venous malformation (venous angioma) in right temporal lobe, with previous hemorrhage within it.

Sir, this is my new report. I would like to know details of this report my current situation by comparing my previous MRI on April. Sorry, there may be some spelling mistakes in this report. Thank you.

-By Nuwan

Reply:

Your previous report showed a calcified granuloma in the frontal region of the brain. This lesion seemed to be inactive in all likelihood.

MRV report has come up with a new finding of a venous malformation. This finding is quite crucial. This lesion also explains your constant complains (symptoms) to some extent.

What Are Venous Malformations?

A venous malformation can be visualized as a tangle of blood vessels in that spot of the brain. Due to the tangle, veins ahead this lesion are dilated.

As you can understand, this dilated bunch of blood vessels presses over the normal brain tissue. This pressure hampers the function of that particular brain area, and may give symptoms.

Different portions of the brain control different functions. Just to give you an idea,

  • Frontal lobe controls the overall personality of the individual.
  • Parietal lobe controls movement of our limbs (hands and legs).
  • Temporal lobe controls speech, memory and understanding.
  • Occipital lobe controls vision.
  • The cerebellum controls walking and coordination.

Since your temporal lobe is affected, functions controlled by it may potentially get disturbed.

Intracranial Hemorrhage

This is one of the dangers of venous angiomas. They may anytime start  bleeding. A pool of blood gets formed in the brain that puts pressure over adjoining brain cells and affects their functions.

Your report tells that you have already got such a hemorrhage. Chances of hemorrhage are more when the blood pressure is high.

Venous malformations are abnormal structures, therefore the walls of blood vessels forming it are weak and liable to leakage on even mildly high B.P.

Other symptoms that may occur in such patients are:

  • Focal or generalized seizures
  • Headache, usually at a particular point of the head

Treatment and Management

Take precaution, keep your B.P. under control. Avoid activities that may elevate blood pressure like lifting heavy weight or straining.

Avoid taking any blood thinning drug like, aspirin or warfarin. They make the blood thin and prone to bleeding.

Treatment modalities include:

Surgery: The malformation is excised out. The surgery is complicated and can be attempted only by an experienced neurosurgeon.

Radiosurgery: Focused high energy beams are thrown over the venous angioma to directly destroy it. A blood clot and a scar tissue is left in place.

Endovascular neurosurgery: After taking an angiography of the brain and knowing the exact location of the angioma, An attempt can be made through the angiography catheter itself to correct the malformation.

You require expert neurosurgeons for your treatment. Meanwhile, medicines may be given to control seizures and any other symptom you have.

Take Care,

Buddy M.D.