Cerebral varix and probable venous angioma: an unusual isolated anomaly.

A 31-year-old man came to the Veterans Administration Medical Center after 3-4 years of right frontal headaches that had been increasing in freq uency and intensity. No other complaints were noted . There was no history of migraine and family history was unremarkable. Physical examination including neurologic testing was completely normal. Init ial CT examination (not shown) was suspicious for an intracran ial aneurysm, and an arteriogram was obtained (fig . 1). The arterial phase on the rig ht side was normal in appearance . Appearing late in the venous phase was a smooth, rou nd, saclike vein that drained a portion of the caudate nucleus and lateral basal ganglia on the right side, and emptied by way of a large single vessel into the sylvian venous system. The appearance of several of the small veins draining the lateral basal ganglia and emptying into the sac was noted. A lateral scout film after the anteroposterior film sequence (the examination was part ly performed in a single plane system) revealed persistent opacificat ion of th is sacl ike vessel fo r several minutes. Subsequent higher resolution CT examination (fig . 2) on the General Electric 8800 scanner revealed a rounded lesion of minimal hyperdensity on the noncontrast portion that enhanced considerably after contrast administration . The two major vessels draining into this venous sac were also noted and corresponded to angiographic changes. In add ition, the caudate nucleus and a part of the lateral basal ganglia appeared to enhance somewhat more than the opposite side. The examination revealed on both sides and in the posterior circulation no evidence of arteriovenous malformation or any other vascular abnormality. There was no sign of vascu litis. The patient was treated conservatively and no operation was performed .