Spontaneous Thrombosis of Drainage Vein in Cavernoma-Associated Developmental Venous Anomaly

Spontaneous Thrombosis of Drainage Vein in Cavernoma-Associated Developmental Venous Anomaly | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Spontaneous Thrombosis of Drainage Vein in Cavernoma-Associated Developmental Venous Anomaly Miguel Ossuna, Pedro Tadao Hamamoto Filho, Marco Antônio Zanini This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6542676/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Oct, 2025 Read the published version in Neuroradiology → Version 1 posted You are reading this latest preprint version Abstract A 57-year-old male with multiple supratentorial and infratentorial cavernomas presented with subacute-onset headache, tinnitus, and worsening neurological deficits. Imaging revealed spontaneous thrombosis of a previously documented developmental venous anomaly (DVA) in the posterior fossa, resulting in cerebellar parenchymal hemorrhage and posterior fossa hypertension consistent with venous infarction. This case highlights the rare occurrence of spontaneous DVA thrombosis, emphasizing its potential for severe complications, such as venous ischemic infarction, parenchymal hemorrhage, venous congestion, or subarachnoid hemorrhage, as well as the importance of sequential imaging in documenting pathological progression. cavernomas venous developmental anomaly thrombosis Figures Figure 1 Figure 2 Main Text A 57-year-old male has been under follow-up at our Neurosurgery Outpatient Clinic since 2002 because of multiple supratentorial and infratentorial cavernomas associated with previous hemorrhages. His previous deficits included incomplete left hemiparesis, left hemihypoesthesia, internuclear ophthalmoplegia, cerebellar syndrome with ataxia, and dysmetry. In addition to cavernomas, previous imaging studies revealed a large developmental venous anomaly (DVA) in the posterior fossa, crossing the midbrain toward the right cerebellopontine angle cistern. The patient sought emergency care complaining of subacute-onset headache, tinnitus, and worsening preexisting neurological deficits. Subsequently, imaging studies were conducted. Computed tomography (CT) revealed spontaneous hyperdensity of the DVA that failed to fill with contrast on venous CT angiography. Subsequent magnetic resonance imaging (MRI) and angiography confirmed the absence of DVA filling, in contrast to prior imaging, indicating DVA thrombosis. The following day, the patient experienced rapid neurological deterioration, which progressed to a decreased level of consciousness. Follow-up CT showed cerebellar parenchymal hemorrhage associated with signs of posterior fossa hypertension, consistent with venous infarction. Ultimately, the patients experienced a fatal outcome. This clinical case illustrates a DVA associated with cavernomas that evolved with spontaneous thrombosis of the DVA drainage vein and consequent parenchymal hemorrhage in the posterior fossa. DVAs are anatomical variants of normal transmedullary veins responsible for draining cerebral white and gray matter. 1-3 Although usually asymptomatic, they can lead to severe clinical manifestations under specific circumstances, such as drainage vein thrombosis. 1,2 Histologically, DVAs consist of thickened hyalinized veins with few or no smooth muscle cells or elastic connective tissue. These structural abnormalities and low blood flow in the drainage veins increase the susceptibility to thrombosis. 1,2 Clinically, patients with DVA thrombosis may present with venous ischemic infarction, parenchymal hemorrhage, venous congestion, or subarachnoid hemorrhage. 2 To the best of our knowledge, this case is significant because of the rarity of spontaneous DVA thrombosis reported in the medical literature. Sequential imaging studies documented these pathological processes. Comparison with prior imaging was crucial to confirm DVA occlusion and correlate it with clinical outcomes. Despite the presence of multiple cavernomas, no related changes or hemorrhages were observed during this clinical episode. 3 Declarations Acknowledgment: none. Funding: none. Declaration of interest: the authors have no conflicts of interest to declare. Ethics statement : ethical approval was waived by the local Ethics Committee of University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. Consent to Participate: The patient died during hospitalization. Informed consent for participation and publication of the images in figures 1 and 2 was obtained from the next of kin. References Kiroglu Y, Oran I, Dalbasti T, Karabulut N, Calli C (2011 April) Thrombosis of a drainage vein in developmental venous anomaly (DVA) leading venous infarction: A case report and review of the literature. J Neuroimaging 21(2):197–201. 10.1111/j.1552-6569.2009.00399.x Amuluru K, Al-Mufti F, Hannaford S, Singh IP, Prestigiacomo CJ, Gandhi CD (2016 March) Symptomatic infratentorial thrombosed developmental venous anomaly: Case report and review of the literature. Interv Neurol 4(3–4):130–137. 10.1159/000444028 Robert T, Villard J, Oumarou G, Daniel RT, Pollo C, Uské A (2013 December) Intracerebellar hemorrhage caused by developmental venous anomaly, from diagnosis to treatment. J Neurol Surg Cent Eur Neurosurg 74(suppl 1):e275–e278. 10.1055/s-0033-1349338 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Oct, 2025 Read the published version in Neuroradiology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6542676","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":452274250,"identity":"11962c2d-7751-4ad3-9e20-ac97128e0f53","order_by":0,"name":"Miguel Ossuna","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYDACZhBRAONVIAni12IA450hRgsDshbGNiK06LazX5P4YMAgJ99/xuzBz3mH8/j5zx5gLtyDW4vZYZ4yyRkGDMYGN3LMDXu3HS6WnJGXwDzjGV4tadI8BgyJGyR4zCR4tx1O3HCDx4CZ5wABLX+AWuYDHSb5d87hxP3nzxDSwn5MGuj9xIYDOWbSvA1AWxhyCNrCbNljIAH0S1qZtMyx9MQZN/ISDs/Ap+X88Yc3flTYAEPs8DbJNzXWif39Zw8+LsCjhYGBBxQpEigiDHg1MDCwP8AwBL+GUTAKRsEoGHEAAI/vTcTa22i/AAAAAElFTkSuQmCC","orcid":"","institution":"São Paulo State University","correspondingAuthor":true,"prefix":"","firstName":"Miguel","middleName":"","lastName":"Ossuna","suffix":""},{"id":452274251,"identity":"34c26a4e-db4f-4187-8be1-10d8843a8c3b","order_by":1,"name":"Pedro Tadao Hamamoto Filho","email":"","orcid":"","institution":"São Paulo State University","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"Tadao Hamamoto","lastName":"Filho","suffix":""},{"id":452274252,"identity":"0da67c77-9f19-43cb-885c-95e61e78d4b9","order_by":2,"name":"Marco Antônio Zanini","email":"","orcid":"","institution":"São Paulo State University","correspondingAuthor":false,"prefix":"","firstName":"Marco","middleName":"Antônio","lastName":"Zanini","suffix":""}],"badges":[],"createdAt":"2025-04-27 23:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6542676/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6542676/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00234-025-03775-y","type":"published","date":"2025-10-09T15:56:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82561810,"identity":"0cab25a8-934e-44a1-be66-7b9ce94fcc69","added_by":"auto","created_at":"2025-05-13 01:40:25","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":354518,"visible":true,"origin":"","legend":"\u003cp\u003e(A) Axial non-contrast brain CT showing a cavernoma in the right middle cerebellar peduncle and a spontaneously hyperdense developmental venous anomaly (DVA). (B) Axial venous brain CT angiography demonstrated the absence of contrast filling in the DVA. (C) Axial non-contrast brain CT performed three days after symptom onset showing cerebellar intraparenchymal hemorrhage and signs of posterior fossa hypertension.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6542676/v1/6974a6d7ee0f683e4db64f29.jpeg"},{"id":82561811,"identity":"fa689331-8e24-452b-a687-07e70826234c","added_by":"auto","created_at":"2025-05-13 01:40:26","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":763404,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of imaging findings conducted before and after symptom onset. Previous contrast-enhanced brain MRI scans (D and F) show a patent developmental venous anomaly (DVA) and draining vein. A contrast-enhanced brain MRI was performed after symptom onset (E and G), which demonstrated thrombosis of the DVA draining vein. Previous digital angiographies (H and J) reveal a large DVA in the posterior fossa, which is no longer visible in the exams performed after symptom onset (I and K).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6542676/v1/78c0a18799907446e863a925.jpeg"},{"id":93419464,"identity":"ce7d837d-d2a0-42ff-8ec4-8df54802134d","added_by":"auto","created_at":"2025-10-13 16:01:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1366812,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6542676/v1/3c523c51-d738-4d57-b3f0-dfe7a99d08fb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Spontaneous Thrombosis of Drainage Vein in Cavernoma-Associated Developmental Venous Anomaly","fulltext":[{"header":"Main Text","content":"\u003cp\u003eA 57-year-old male has been under follow-up at our Neurosurgery Outpatient Clinic since 2002 because of multiple supratentorial and infratentorial cavernomas associated with previous hemorrhages. His previous deficits included incomplete left hemiparesis, left hemihypoesthesia, internuclear ophthalmoplegia, cerebellar syndrome with ataxia, and dysmetry. In addition to cavernomas, previous imaging studies revealed a large developmental venous anomaly (DVA) in the posterior fossa, crossing the midbrain toward the right cerebellopontine angle cistern.\u003c/p\u003e\n\u003cp\u003eThe patient sought emergency care complaining of subacute-onset headache, tinnitus, and worsening preexisting neurological deficits. Subsequently, imaging studies were conducted. Computed tomography (CT) revealed spontaneous hyperdensity of the DVA that failed to fill with contrast on venous CT angiography. Subsequent magnetic resonance imaging (MRI) and angiography confirmed the absence of DVA filling, in contrast to prior imaging, indicating DVA thrombosis.\u003c/p\u003e\n\u003cp\u003eThe following day, the patient experienced rapid neurological deterioration,\u0026nbsp;which progressed to a decreased level of consciousness. Follow-up CT showed cerebellar parenchymal hemorrhage associated with signs of posterior fossa hypertension, consistent with venous infarction. Ultimately, the patients experienced a fatal outcome.\u003c/p\u003e\n\u003cp\u003eThis clinical case illustrates a DVA associated with cavernomas\u0026nbsp;that evolved with spontaneous thrombosis of the DVA drainage vein and consequent parenchymal hemorrhage in the posterior fossa. DVAs are anatomical variants of normal transmedullary veins responsible for draining cerebral white and gray matter.\u003csup\u003e1-3\u003c/sup\u003e Although usually asymptomatic, they can lead to severe clinical manifestations under specific circumstances, such as drainage vein thrombosis.\u003csup\u003e1,2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eHistologically, DVAs consist of thickened hyalinized veins with few or no smooth muscle cells or elastic connective tissue. These structural abnormalities and low blood flow in the drainage veins increase\u0026nbsp;the susceptibility to thrombosis.\u003csup\u003e1,2\u003c/sup\u003e Clinically, patients with DVA thrombosis may present with venous ischemic infarction, parenchymal hemorrhage, venous congestion, or subarachnoid hemorrhage.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, this case is significant because of the rarity of spontaneous DVA thrombosis\u0026nbsp;reported in the medical literature. Sequential imaging studies documented these pathological processes. Comparison with prior imaging was crucial to confirm DVA occlusion and correlate it with clinical outcomes. Despite the presence of multiple cavernomas, no related changes or hemorrhages were observed during this clinical episode.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003enone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003enone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest:\u0026nbsp;\u003c/strong\u003ethe authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e: ethical approval was waived by the local Ethics Committee of University in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003e The patient died during hospitalization. Informed consent for participation and publication of the images in figures 1 and 2 was obtained from the next of kin.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKiroglu Y, Oran I, Dalbasti T, Karabulut N, Calli C (2011 April) Thrombosis of a drainage vein in developmental venous anomaly (DVA) leading venous infarction: A case report and review of the literature. J Neuroimaging 21(2):197\u0026ndash;201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1552-6569.2009.00399.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1552-6569.2009.00399.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmuluru K, Al-Mufti F, Hannaford S, Singh IP, Prestigiacomo CJ, Gandhi CD (2016 March) Symptomatic infratentorial thrombosed developmental venous anomaly: Case report and review of the literature. Interv Neurol 4(3\u0026ndash;4):130\u0026ndash;137. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1159/000444028\u003c/span\u003e\u003cspan address=\"10.1159/000444028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobert T, Villard J, Oumarou G, Daniel RT, Pollo C, Usk\u0026eacute; A (2013 December) Intracerebellar hemorrhage caused by developmental venous anomaly, from diagnosis to treatment. J Neurol Surg Cent Eur Neurosurg 74(suppl 1):e275\u0026ndash;e278. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-0033-1349338\u003c/span\u003e\u003cspan address=\"10.1055/s-0033-1349338\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cavernomas, venous developmental anomaly, thrombosis","lastPublishedDoi":"10.21203/rs.3.rs-6542676/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6542676/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 57-year-old male with multiple supratentorial and infratentorial cavernomas presented with subacute-onset headache, tinnitus, and worsening neurological deficits. Imaging revealed spontaneous thrombosis of a previously documented developmental venous anomaly (DVA) in the posterior fossa, resulting in cerebellar parenchymal hemorrhage and posterior fossa hypertension consistent with venous infarction. This case highlights the rare occurrence of spontaneous DVA thrombosis, emphasizing its potential for severe complications, such as venous ischemic infarction, parenchymal hemorrhage, venous congestion, or subarachnoid hemorrhage, as well as the importance of sequential imaging in documenting pathological progression.\u003c/p\u003e","manuscriptTitle":"Spontaneous Thrombosis of Drainage Vein in Cavernoma-Associated Developmental Venous Anomaly","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 01:32:21","doi":"10.21203/rs.3.rs-6542676/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6c9bebd6-c5d8-4258-bd94-4512c2741837","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T15:58:55+00:00","versionOfRecord":{"articleIdentity":"rs-6542676","link":"https://doi.org/10.1007/s00234-025-03775-y","journal":{"identity":"neuroradiology","isVorOnly":false,"title":"Neuroradiology"},"publishedOn":"2025-10-09 15:56:56","publishedOnDateReadable":"October 9th, 2025"},"versionCreatedAt":"2025-05-13 01:32:21","video":"","vorDoi":"10.1007/s00234-025-03775-y","vorDoiUrl":"https://doi.org/10.1007/s00234-025-03775-y","workflowStages":[]},"version":"v1","identity":"rs-6542676","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6542676","identity":"rs-6542676","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}