Article Figures & Data
Figures
- Fig 1.
A 70-year-old woman presenting with acute onset of headache and left-sided weakness. A, Noncontrast head CT scan demonstrates a large right frontoparietal lobar hemorrhage with surrounding vasogenic edema. This hemorrhage was subsequently shown to be due to a right hemispheric arteriovenous malformation with intranidal and flow-related aneurysms. B, CT scan caudal to A demonstrates calcification of the right caudate and anterior putamen, with sparing of the anterior limb of the internal capsule. C, Axial T2 MR image at a similar level demonstrates normal to slightly decreased signal intensity in the right caudate and putamen. Mild sulcal effacement in the right hemisphere is due to mass effect from the more superior parenchymal hematoma. Despite this, the right frontal horn is mildly dilated compared with the left. D, Axial T1 postgadolinium image demonstrates a DVA involving the right caudate and putamen. This DVA drains into an ependymal vein, likely the right thalamostriate vein, which is partly included on this image (arrow).
- Fig 2.
A 50-year-old man presenting with headache. A, Noncontrast CT scan of the brain demonstrates calcification involving the left caudate and putamen without mass effect and with some encroachment on but relative sparing of the anterior limb of the internal capsule. Mild asymmetric prominence of the left frontal ventricular horn is consistent with mild volume loss. B, Coronal gradient recalled-echo image demonstrates signal-intensity loss due to susceptibility effects in the distribution of the basal ganglia mineralization. C, Axial T1 postgadolinium MR image demonstrates enhancing venous radicles in the left basal ganglia, converging on a common venous stem that courses toward the adjacent ventricular surface. Findings of T2- and diffusion-weighted images (not shown) were normal.
- Fig 3.
A 48-year-old woman presenting with headache and seizure. A, An axial source image from CTA demonstrates mineralization of the right caudate and anterior putamen, with sparing of the anterior limb of the internal capsule. The patient's noncontrast head CT (not shown) also demonstrated this finding. An adjacent developmental venous anomaly (white arrows) is demonstrated in the periventricular white matter, coursing toward the midline. B, Lateral-projection venous phase image from a catheter angiogram demonstrates the venous radicles of the DVA converging toward a common venous pouch (P). A focal stenosis (large black arrow) manifested as a caliber transition zone is present where the pouch meets the inferior sagittal sinus; a second possible stenosis is present at the point where the inferior sagittal sinus drains to the Galenic system.
- Fig 4.
A 39-year-old man with a history of antithrombin III deficiency, presenting with headache and suspicion for intracranial hemorrhage. Some years earlier, the patient had been told that he had a “right basal ganglia hemorrhage.” A, Noncontrast head CT demonstrates unilateral mineralization of the right caudate and anterior putamen, with relative sparing of the anterior limb of the internal capsule, which can be seen between the caudate and putaminal mineralization. B, Axial fluid-attenuated inversion recovery MR image shows no hyperintensity in the right caudate or putamen but rather a subtle hypointensity due to the calcification. The right frontal horn is mildly dilated, consistent with subtle volume loss in the right basal ganglia. C, Axial T1 postgadolinium image demonstrates a deep DVA involving the right basal ganglia and draining toward a right subependymal vein and then to the right septal vein (arrow). A second more superficial DVA is present in the subcortical right frontal region. Mild asymmetric prominence of the right frontal ventricular horn is again consistent with subtle parenchymal volume loss.
Tables
Clinical and imaging characteristics of study population
Characteristics Patient 1 2 3 4 5 6 General Age (yr)/sex 50/M 39/M 79/F 70/F 48/F 30/M Presentation HA HA ICH ICH HA, SZ HA CT Side L R R R R R Ca2+ distributiona C + P C + Pb C + Pb C + P C + P C + P CTA NA DVA, otherwise negative NA AVM, DVA; otherwise negative Large DVA with venous restriction NA MR imaging Mass effect – – – – –c – T2 Change – – – – NA – DVA drainage Deep Deep Deep Deep Deep Deep Angiography Venous restriction NA – NA – + NA Additional features Ipsilateral prominence of frontal horn Ipsilateral prominence of frontal horn, Ipsilateral prominence of frontal horn, Ipsilateral prominence of frontal horn, 2nd DVA, periphery right frontal lobe Right frontal lobar ICH Right frontal/parietal lobar ICH Note:— –indicates negative.
a Preferential calcification of the caudate and anterior putamen was noted in all cases, with at least partial sparing of the anterior limb of the internal capsule.
b Trace high density of the globus pallidus interna was noted, characteristic of senescent mineralization, involving the globus pallidus interna on the left in case 2 and bilaterally in case 3.
c MR imaging was not available; cross-sectional assessment was performed by CT and CTA.
