Cavernous malformations with DVA: Hold those knives

Cerebral cavernous malformations (CMs) are angiographically occult vascular cavities lined by endothelial cells without tight junctions. While CMs can present with hemorrhage, seizures, or focal neurologic deficits, they are frequently found incidentally on brain MRI. They can occur sporadically (typically single) or as part of a familial syndrome (often multiple). On standard MRI (1.5T), at least one-fourth of sporadic CMs are associated with a developmental venous anomaly (DVA), a radial cluster of dilated venous vessels that converge to drain into an enlarged collecting vein. It has been postulated that DVAs can contribute to the formation of sporadic CMs through hemodynamic mechanisms.(1) The facts that the prevalence of DVA-associated CMs increases with age(2) and that DVAs occur with sporadic but not with familial CMs3 support a pathogenic link. Actually, abnormal venous drainage has consistently been found in association with sporadic CMs when high-sensitivity brain imaging (such as 7T MRI) is used.(4