A 15-year-old boy presented to our hospital with headache after head trauma caused by a traffic accident. T2-weighted axial MR-images demonstrated the deep medullary veins of the cerebellum converging on the roof of the fourth ventricle. These veins drained into the subependymal vein, which then drained into the precentral cerebellar vein (Figure 1). MR-cisternography with 3D Fourier transformation constructive interference in steady state (CISS), which can depict the venous anatomy when is surrounded by CSF, demonstrated a dilated precentral cerebellar vein located in the fourth ventricle. This dilated precentral cerebellar veinran adjacent to exit area of the aqueduct of Sylvius, penetrated the superior medullary velum and finally drained into the vein of Galen (Figure 2). The lesion was diagnosed as a developmental venous anomaly (DVA). MR-images did not show any hemorrhage or ventricular dilatation. This young man did not require any specific medical treatment for his venous anomaly.

Developmental venous anomalies (DVAs) are known as congenital intracranial vascular lesion. Most DVAs are asymptomatic; however, they may occasionally cause obstructive hydrocephalus and should be considered in cases of chronic or intermittent headaches (2,3). Paulson et al reported a case with hydrocephalus caused by the DVA passing through the orifice of the aqueduct and referred 10 previously reported cases which had presented with hydrocephalus (2). Their conclusion was that no surgical treatment was necessary for the DVAs for itself, but CSF diversion might be necessary in some cases. Although MR-images demonstrated a dilated precentral cerebellar vein adjacent to the aqueduct in our case which presented with headache, an aqueduct stenosis resulting in hydrocephalus was not present and surgical intervention was not considered necessary.

1.           Lee C, Pennington MA, Kenney CM. MR evaluation of developmental venous anomalies: medullary venous anatomy of venous angiomas. AJNR 1996;17:61–70.

2.           Paulson D, Hwang SW, Whitehead WE, Curry DJ, Luerssen TG, Jea A: Aqueductal developmentalvenousanomaly as an unusual cause of congenital hydrocephalus: a case report and review of the literature. J Med Case Rep. 2012 Jan 11;6:7.

3.           Giannetti AV, Rodrigues RB, Trivelato FP. Venous lesions as a cause of sylvianaqueductal obstruction: case report. Neurosurgery. 2008;62:E1167–1168. discussion E1168