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A Rare Case of Cerebral Venous Anomaly Presenting with an Epileptic Seizure

Yıl 2023, Cilt: 6 Sayı: 1, 37 - 40, 08.03.2023
https://doi.org/10.54996/anatolianjem.1092947

Öz

Aim: Although there are names such as 'venous angioma' and 'cerebral venous malformation,' they are now called developmental venous anomalies. The most common form of venous anomaly is cerebral vascular malformation. They are usually detected incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) scans. In addition, it may present with hemorrhage, ischemic stroke, epileptic seizure, or headache in clinical practice. It is aimed to emphasize that cerebral venous anomalies can be a rare cause of epileptic seizures in this study.

Case: A 24-year-old male patient with no previous history of epilepsy or other disease was brought to the emergency department with convulsions and loss of consciousness in all four extremities, similar to generalized tonic-clonic seizures. It was learned that there were contractions in the whole body, urinary incontinence, foaming at the mouth, and locking in the jaw, which lasted for two minutes, and he remained unconscious for 1 hour. There was no feature in his or his family’s medical history. He was conscious and cooperative. His vital signs were: blood pressure: 125/80 mmHg, pulse: 88 beats/min, respiratory rate: 13/min, fever: 36°C. All other system examinations, including the neurological system, were unremarkable. Complete blood count, electrolyte values, and liver and kidney function tests provided normal results. No abnormal findings were found on the CT scan of the brain. In the follow-up examination, a contrast-enhanced brain MRI was performed due to persistent vomiting and headache. Contrast-enhanced brain MRI showed hyperintense in T1 and T2 sequences and heterogeneous contrast transition in contrast-enhanced sequences, extending from the subcutaneous region to the parenchyma in the right occipital region. Brain MR venography revealed a venous malformation extending from under the skin to the cerebral venous system in the occipital region and draining. Since the patient had a neuroradiologically pathological risk factor, 1000 mg/day of levetiracetam was started as an antiepileptic treatment, even though he had his first epileptic seizure.

Conclusion: Developmental venous anomalies may present with hemorrhage, ischemic stroke, epileptic seizure, focal neurological deficits, or headache in clinical practice. In neurology clinics, the first epileptic seizure cases at a young age are frequently encountered as primary epileptic seizures. However, it should be kept in mind that rare clinical situations, such as in this case, may also present with epileptic seizures in young patients, and etiologic examinations should be planned accordingly.

Kaynakça

  • Young AE. Pathogenesis of vascular malformations. In: Mulliken JB, Young AE, editors. Vascular birthmarks. Philadelphia: WB Saunders 1988: 107-12.
  • Sarwar M, McCormick WF. Intracerebral venous angioma. Case report and review. Arch Neurol 1978;35:323–5.
  • Ruíz DSM, Yilmaz H, Gailloud P. Cerebral developmental venous anomalies: current concepts. Ann Neurol 2009;66:271–83. doi:10.1002/ana.21754.
  • Lasjaunias P, Burrows P, Planet C. Developmental venous anomalies (DVA): the socalled venous angioma. Neurosurg Rev 1986;9:233–42.
  • San Millán Ruíz D, Delavelle J, Yilmaz H, et al. Parenchymal abnormalities associated with developmental venous anomalies. Neuroradiology 2007;49:987–95. doi:10.1007/s00234-007-0279-0.
  • Abe M, Kjelberg RN, Adams RD. Clinical presentations of vascular malformations of the brain stem;comparison of anjiyographically positive and negative types. J Neurol Neurosurg Psychiatry 1989; 52(2): 167-175.
  • Töpper R, Jürgens E, Reul J, et al. Clinical significance of intracranial developmental venous anomalies. J Neurol Neurosurg Psychiatry 1999; 67: 234–238.
  • Paltiel HJ, Burrows PE, Kozakewich HPW, et al. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 2000; (214): 747-754.
  • Boukobza M, Enjolras O, Guichard JP, et al. Cerebral developmental venous anomalies associated with head and neck venous malformations. AJNR Am J Neuroradiol 1996; (17): 987-994.
  • Rigamonti D, Spetzler RF, Drayer BP, et al. Appearance of venous malformations on magnetic resonance imaging. J Neurosurg 1988;69:535–9. doi:10.3171/jns.1988.69.4.0535.
  • Wilms G, Demaerel P, Marchal G, et al. Gadolinium-enhanced MR imaging of cerebral venous angiomas with emphasis on their drainage. J Comput Assist Tomogr 1991;15:199–206.
  • Zouaoui A, Hidden G. Cerebral venous sinuses: anatomical variants or thrombosis? Acta Anat (Basel) 1988;133:318–24.
  • Buckmiller LM, Richter GT, Suen JY. Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Diseases 2010; (16): 405–418.
  • Ferro JM, Canhão P. Acute treatment of cerebral venous and dural sinus thrombosis. Curr Treat Options Neurol 2008;10:126–37.

Epileptik Nöbet ile Prezente Olan Nadir Bir Serebral Venöz Anomali Olgusu

Yıl 2023, Cilt: 6 Sayı: 1, 37 - 40, 08.03.2023
https://doi.org/10.54996/anatolianjem.1092947

Öz

Amaç: ‘Venöz anjiom’, ‘serebral venöz malformasyon’ olarak isimlendirmeler olsa da günümüzde gelişimsel venöz anomaliler olarak adlandırılmaktadır. Venöz anomalilerin en sık görülen şekli serebral vasküler malformasyonlardır. Genellikle bilgisayarlı tomografi (BT) veya manyetik rezonans görüntüleme (MRG) taramalarında insidental saptanırlar. Bunun yanısıra hemoraji, iskemik inme, epileptik nöbet veya baş ağrısı ile klinik pratikte karşımıza çıkabilir. Bu çalışmada serabral venöz anomalilerin nadir bir epileptik nöbet nedeni olabileceğinin vurgulanması amaçlanmıştır.

Olgu: Daha önce epilepsi ve başka hastalık öyküsü olmayan 24 yaşında erkek hasta jeneralize tonik klonik nöbete benzer şekilde dört ekstermitede birden olan kasılma ve bilinç kaybı ile acil servise getirildi. İki dakika süren tüm vücutta kasılma, idrar inkontinansı, ağızda köpürme ve çenede kitlenme olduğu ve 1 saat boyunca bilincinin kapalı kaldığı öğrenildi. Özgeçmiş ve soygeçmişinde özellik yoktu. Bilinç açık koopere oryante idi. Vital bulgularında; kan basıncı: 125/80 mmHg, nabız: 88 atım/dk, solunum sayısı: 13/dk, ateş: 36°C olarak ölçüldü. Nörolojik sistem dahil diğer tüm sistem muayeneleri olağandı. Yapılan tam kan sayımı, elektrolit değerleri, karaciğer ve böbrek fonksiyon testleri normaldi. Beyin BT normal saptandı. Takipte dirençli kusması ve baş ağrısının olması üzerine kontrastlı beyin MRG yapıldı. Kontrastlı beyin MRG’nde sağ oksipitalde cilt altı bölgeden parankime uzanan T1 ve T2 sekansta hiperintens, kontrastlı sekansta heterojen kontrast geçişi şeklinde görünüm izlendi. Beyin MR venografide oksipitalde cilt altından serebral venöz sisteme uzanıp drene olan venöz malformasyon saptandı. Hastanın nöroradyolojik açıdan patolojik bir risk faktörü olması sebebiyle, ilk epileptik nöbeti olmasına rağmen hastaya antiepileptik tedavi olarak 1000 mg/gün levetirasetam başlandı.

Sonuç: Gelişimsel venöz anomaliler hemoraji, iskemik inme, epileptik nöbet, fokal nörolojik defisitlerle veya baş ağrısı ile klinik pratikte karşımıza çıkabilir. Nöroloji kliniklerinde genç yaş ilk epileptik nöbet olguları sıklıkla primer epileptik nöbetler olarak karşımıza çıkmaktadır. Ancak bu vakada olduğu gibi nadir görülen klinik tabloların da genç yaş hastalarda epileptik nöbet ile karşımıza çıkabileceği unutulmamalı ve yapılacak etiyolojik tetkikler buna göre planlanmalıdır.

Kaynakça

  • Young AE. Pathogenesis of vascular malformations. In: Mulliken JB, Young AE, editors. Vascular birthmarks. Philadelphia: WB Saunders 1988: 107-12.
  • Sarwar M, McCormick WF. Intracerebral venous angioma. Case report and review. Arch Neurol 1978;35:323–5.
  • Ruíz DSM, Yilmaz H, Gailloud P. Cerebral developmental venous anomalies: current concepts. Ann Neurol 2009;66:271–83. doi:10.1002/ana.21754.
  • Lasjaunias P, Burrows P, Planet C. Developmental venous anomalies (DVA): the socalled venous angioma. Neurosurg Rev 1986;9:233–42.
  • San Millán Ruíz D, Delavelle J, Yilmaz H, et al. Parenchymal abnormalities associated with developmental venous anomalies. Neuroradiology 2007;49:987–95. doi:10.1007/s00234-007-0279-0.
  • Abe M, Kjelberg RN, Adams RD. Clinical presentations of vascular malformations of the brain stem;comparison of anjiyographically positive and negative types. J Neurol Neurosurg Psychiatry 1989; 52(2): 167-175.
  • Töpper R, Jürgens E, Reul J, et al. Clinical significance of intracranial developmental venous anomalies. J Neurol Neurosurg Psychiatry 1999; 67: 234–238.
  • Paltiel HJ, Burrows PE, Kozakewich HPW, et al. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 2000; (214): 747-754.
  • Boukobza M, Enjolras O, Guichard JP, et al. Cerebral developmental venous anomalies associated with head and neck venous malformations. AJNR Am J Neuroradiol 1996; (17): 987-994.
  • Rigamonti D, Spetzler RF, Drayer BP, et al. Appearance of venous malformations on magnetic resonance imaging. J Neurosurg 1988;69:535–9. doi:10.3171/jns.1988.69.4.0535.
  • Wilms G, Demaerel P, Marchal G, et al. Gadolinium-enhanced MR imaging of cerebral venous angiomas with emphasis on their drainage. J Comput Assist Tomogr 1991;15:199–206.
  • Zouaoui A, Hidden G. Cerebral venous sinuses: anatomical variants or thrombosis? Acta Anat (Basel) 1988;133:318–24.
  • Buckmiller LM, Richter GT, Suen JY. Diagnosis and management of hemangiomas and vascular malformations of the head and neck. Oral Diseases 2010; (16): 405–418.
  • Ferro JM, Canhão P. Acute treatment of cerebral venous and dural sinus thrombosis. Curr Treat Options Neurol 2008;10:126–37.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Vaka Takdimi
Yazarlar

Burçin Durmuş 0000-0001-6004-3676

Sefer Özkaya 0000-0001-9794-7775

Erken Görünüm Tarihi 9 Mart 2023
Yayımlanma Tarihi 8 Mart 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 6 Sayı: 1

Kaynak Göster

AMA Durmuş B, Özkaya S. Epileptik Nöbet ile Prezente Olan Nadir Bir Serebral Venöz Anomali Olgusu. Anatolian J Emerg Med. Mart 2023;6(1):37-40. doi:10.54996/anatolianjem.1092947