Implication of developmental venous anomalies (DVA) in epilepsy
Sophio ROSTOMASHVILI*, Cecile CAUQUIL-MICHON *,Ghaida NASSER **, Denis DUCREUX **, David ADAMS *, Christian DENIER * Pascal MASNOU*.
Departement of Neurology, Kremlin Bicetre university hospital, Paris, France
Service de Neuroradiology, Kremlin Bicetre university hospital, Paris, France
Background: Developmental venous anomalies (DVA) are congenital anatomical variants of normal venous drainage of normal brain. DVAs are rarely symptomatic. Intra cerebral haemorrhage (ICH) or thrombosis leading to venous infarction may occur in some patients. Nevertheless, it is generally accepted that DVA are not epileptogenic.
Objective: We report 4 cases of intracranial DVA revealed by seizures and discuss the physiopathology of epilepsy associated with DVA
Design: In all patients the diagnosis was based on the clinical history, cerebral MRI and ictal video-EEG recording.
Results: In two patients ’’non complicated’’ DVA was identified without any associated cerebral lesion. In both cases a concordant epileptic focus was confirmed on ictal video EEG recording. The third patient had a left temporo-parietal DVA associated with a low-intensity cortical lesion in T2*-weighted images suggesting possible sequela of a venous infarction. In this case, seizures originating from left temporo-parietal region were recorded. The last patient had a left lobar hematoma, revealed by convulsive seizure associated with venous infarction of the DVA, confirmed by arteriography. There was no associated cavernoma in any patient.
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Conclusion – Epilepsy may occur in association with DVA. The physiopathological process is probably different in each patient: Vascular epilepsy may be an explanation in some DVA associated with haemorrhage or thrombosis. Nevertheless, in some cases of “non complicated” DVA, flow related imbalance with the increase of inflow or outflow restriction might also produce cortical dysfunction inducing epileptic focus.
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