Engorgement of Deep Medullary Veins in Neurosarcoidosis: A Common-Yet-Underrecognized Cerebrovascular Finding on SWI

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Fig 1.
A 46-year-old man with word-finding difficulties, seizures, and vision loss. SWI minimum-intensity-projection images (A) demonstrates engorged and tortuous deep medullary veins perpendicular to the long axis of the lateral ventricles (arrows), with a fanned configuration around the frontal horns. Thick-slab (12-mm) postcontrast MPRAGE MIP image (B) shows corresponding enhancement (arrowheads). There is also ventriculomegaly.
Download figure
Open in new tab
Download powerpoint
Fig 2.
A 48-year-old man presenting with confusion. SWI minimum-intensity-projection images (A and B) show engorged and tortuous deep medullary veins bilaterally (arrows). Note thinner and relatively faint deep medullary veins in the right frontal lobe (arrowheads in A). There is also corresponding enhancement in the postcontrast MPRAGE MIP image (arrow in C).
Download figure
Open in new tab
Download powerpoint
Fig 3.
A 23-year-old man presenting with severe headaches, nausea, vomiting, and confusion. SWI minimum-intensity-projection image (A) demonstrates engorged deep medullary veins bilaterally (thick arrows) with corresponding enhancement on the postcontrast MPRAGE MIP image (B). There are numerous microhemorrhages bilaterally (arrowheads in A) and a macrohemorrhage in the left temporal lobe (asterisk in C) with surrounding edema seen on the T2 image. Note extensive nodular perivascular enhancement in B (thin arrows).

Basic demographics, symptoms, MRI findings, and modified Rankin Scale scores of patients with neurosarcoidosis

Characteristics	Total (%)	DMVE (+) (%)	DMVE (−) (%)	P Value
No.	21	7	14
Age (mean ± SD) (yr)	46 ± 14	45 ± 13	47 ± 16	.813
Sex (M/F)	10/11	6/1	4/10	.013^{^a}
Symptoms
Headache	8 (38%)	4 (57%)	4 (29%)	.346
Vision loss	5 (24%)	1 (14%)	4 (29%)	.624
Seizure	3 (14%)	0 (0%)	3 (21%)	.521
Extremity weakness	3 (14%)	1 (14%)	2 (14%)	1
Cranial neuropathy	2 (10%)	0 (0%)	2 (14%)	.533
Gait instability	3 (14%)	2 (29%)	1 (7%)	.247
Bowel/bladder dysfunction	4 (19%)	3 (43%)	1 (7%)	.088
Others	4 (19%)	1 (14%)	3 (21%)
Intracranial hemorrhage
Microhemorrhage	7 (33%)	5 (71%)	2 (14%)	.009^{^a}
Macrohemorrhage	1 (5%)	1 (14%)	0 (0%)	.147
Enhancing disease
Leptomeningeal	13 (62%)	4 (57%)	9 (64%)	.751
Pachymeningeal	8 (38%)	3 (43%)	5 (36%)	.751
Perivascular	3 (14%)	3 (43%)	0 (0%)	.008^{^a}
Venous thrombosis	2 (10%)	1 (14%)	1 (7%)	.599
Hydrocephalus	6 (29%)	4 (57%)	2 (14%)	.040^{^a}
Modified Rankin Scale score (mean)
At initial MRI (n = 20)		3.2 ± 0.75	2.1 ± 1.5	.125
At follow-up (n = 18)		2.4 ± 1.1	1.5 ± 1.1	.167