Vein of Galen aneurysmal malformation presenting as prominent scalp veins

摘要

An 11-month-old female infant was referred with prominent scalp veins, first noted at age 6 months.Examination showed very large veins over all her scalp, extending down the forehead including medial to both eyes at the nasal bridge (fig 1). The scalp veins ran in palpable ridges and bulged during crying -or straining. No scalp bruit was audible. Head circumference (48.7 cm) had increased to the 91st centile, having been on the 50th centile at birth. Systemic examination was otherwise unremarkable and developmental progress normal to date.An MR brain scan showed striking dilatation of the persistent median prosencephalic vein of Markowski, with several dilated arterial feeders, bilateral jugular bulb occlusion, and dilated cortical veins (fig 2). There was reflux into the petrosal sagittal sinus and into the cavernous sinus towards the orbit. Brain parenchyma appeared normal with no hydrocephalus. The findings confirmed a typical vein of Galen aneurysmal malformation.