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Surgical extirpation of a venous angioma of the medulla oblongata simulating multiple sclerosis
Menachem Sadeh, M.D., ∗, Itzchak Shacked, M.D.†, Z.Harry Rappaport, M.D.†, Rina Tadmor, M.D.‡
a Department of Neurology, Sheba Medical Center, Tel Hashomer, and The Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
b Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, and The Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
c Department of Radiology, Sheba Medical Center, Tel Hashomer, and The Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
Abstract
A case of a venous angioma of the medulla oblongata is presented. The case is unusual in that it had a fluctuating course for over 12 years that mimicked multiple sclerosis. The natural history of this entity is reviewed and early surgical therapy is advocated.
Keywords
venous angioma; brain stem; multiple sclerosis; vascular malformation; medulla oblongata

A venous angioma is a small abnormal tangle of veins that can occur in the brain. Although not technically normal, some people consider a venous angioma, or venous malformation, a normal variant because it occurs fairly frequently (probably in at least a few percent of all people) and because it is rarely associated with any symptoms, hemorrhage or other problems.
Venous malformations should not be confused with other cerebrovascular malformations such as a cavernous malformation or arteriovenous malformation. These more rare malformations of the blood vessels in the brain are much more likely to bleed and cause significant symptoms.

Occasionally, an angioma can be associated with another malformation, most commonly a cavernous malformation. In these cases the angioma is just incidental and the real pathology of concern is the cavernous malformation, not the angioma.

Posterior fossa venous angiomas with drainage through the brain stem.
T R Damiano, C L Truwit, C F Dowd, D L Symonds, L Portela and J Dreisbach
+ Author Affiliations
Department of Radiology, Fitzsimons Army Medical Center, Aurora, Colo.
Abstract

PURPOSE To describe 11 cases of posterior fossa venous angiomas with drainage through the brain stem.

METHODS Eleven cases of posterior fossa venous angioma with drainage through the brain stem were evaluated using MR. Correlation with known routes of venous drainage for the cerebellum and brain stem is made.

RESULTS Six of the 11 venous angiomas were found in the cerebellum, four in the brain stem; one involved both the cerebellum and brain stem. The cerebellar venous angiomas drained to subependymal veins about the fourth ventricle and dorsal pons. These then connected with an enlarged transmesencephalic or transpontine vein, to drain anteriorly to the anterior pontine veins. The brain stem angiomas had variable drainage depending on location. Evidence of hemorrhage was seen in five cases.

CONCLUSION Cerebellar and brain stem venous angiomas have several potential routes of drainage, including an enlarged vein traversing the pons, midbrain, or medulla. A knowledge of the normal venous anatomy of this region helps to understand the occurrence of these uncommon routes of venous drainage.

Copyright © American Society of Neuroradiology

Although not technically normal, some people consider a venous angioma, or venous malformation, a normal variant because it occurs fairly frequently (probably in at least a few percent of all people) and because it is rarely associated with any symptoms, hemorrhage or other problems.

Does this make anyone else think of the alternate blood flow routes that are present in CCSVI?

Cece wrote:if flow can't get out one way, it has to get out another way, and/or it slows down

have you read much about angiogenesis and collaterals?

With the venous angioma, is the problem that the angioma and the enlarged blood vessels are compressing the areas of the brain, or is there disruption in flow? In the first research posted, why did the symptoms of the angioma fluctuate over so many years, mimicking MS?

It's interesting research, thanks for sharing it.

Clinicalpresentationsofvascularmalformationsof the brain stem: comparison of angiographically positiveandnegativetypes
MASAMITSU ABE, RAYMOND N KJELLBERG, RAYMOND D ADAMS
FromtheDepartmentsofNeurosurgeryandNeurology,MassachusettsGeneralHospital,Boston,MA, USA
SUMMARY Clinicalandradiographicfeaturesof63patientswithavascularmalformationofthe brainstem are described.On radiologicalgroundstheywere dividedintotwo groups: one with angiographicallyvisiblelesions(AVAVMs),theotherwithlesionsnotseen angiographically,thatis, occult(AOVMs).Inthefirstgroup theinitialclinicalmanifestationwas duetohaemorrhagein20of the33cases andconsistedofa progressiveneurologicaldeficitin12.Inthesecondgroup 29ofthe30 initialypresentedwitha brainstemhaemorrhage.Thelaterwas oftencharacterisedbydevelopment ofsymptoms over two daysor more (16cases),absenceofheadache(48cases)andtendencyto recurrence (20cases).Clinicaldiagnosiswas dificultinmany cases especiallyintheAOVM group. Severalofthepatientswere misdiagnosedas havingmultiplesclerosis.Clinicaldatainconjunction withmagneticresonance imagingwere helpfulindeterminingthenatureoftheselesions.