Abstract

Aim: Although there are names such as 'venous angioma' and 'cerebral venous malformation,' they are now called developmental venous anomalies. The most common form of venous anomaly is cerebral vascular malformation. They are usually detected incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) scans. In addition, it may present with hemorrhage, ischemic stroke, epileptic seizure, or headache in clinical practice. It is aimed to emphasize that cerebral venous anomalies can be a rare cause of epileptic seizures in this study.

Case: A 24-year-old male patient with no previous history of epilepsy or other disease was brought to the emergency department with convulsions and loss of consciousness in all four extremities, similar to generalized tonic-clonic seizures. It was learned that there were contractions in the whole body, urinary incontinence, foaming at the mouth, and locking in the jaw, which lasted for two minutes, and he remained unconscious for 1 hour. There was no feature in his or his family’s medical history. He was conscious and cooperative. His vital signs were: blood pressure: 125/80 mmHg, pulse: 88 beats/min, respiratory rate: 13/min, fever: 36°C. All other system examinations, including the neurological system, were unremarkable. Complete blood count, electrolyte values, and liver and kidney function tests provided normal results. No abnormal findings were found on the CT scan of the brain. In the follow-up examination, a contrast-enhanced brain MRI was performed due to persistent vomiting and headache. Contrast-enhanced brain MRI showed hyperintense in T1 and T2 sequences and heterogeneous contrast transition in contrast-enhanced sequences, extending from the subcutaneous region to the parenchyma in the right occipital region. Brain MR venography revealed a venous malformation extending from under the skin to the cerebral venous system in the occipital region and draining. Since the patient had a neuroradiologically pathological risk factor, 1000 mg/day of levetiracetam was started as an antiepileptic treatment, even though he had his first epileptic seizure.

Conclusion: Developmental venous anomalies may present with hemorrhage, ischemic stroke, epileptic seizure, focal neurological deficits, or headache in clinical practice. In neurology clinics, the first epileptic seizure cases at a young age are frequently encountered as primary epileptic seizures. However, it should be kept in mind that rare clinical situations, such as in this case, may also present with epileptic seizures in young patients, and etiologic examinations should be planned accordingly.