Incidental post-mortem finding of a vein of <i>Galen aneurysm</i> following a road traffic accident death with review of literature

Abstract

Background: Vein of Galen aneurysmal malformations are rare childhood intracranial vascular anomalies. They account for less than 1% of cerebral
vascular malformations.
Case Report: A 7-year-old male presented with post traumatic altered sensorium and quadriparesis. Head and neck examinations showed macrocephaly, occipital scalp abrasions. Glasgow Coma Score was 9/15. Both pupils were 3mm bilaterally and reacted briskly to light. Cranial computed tomography (CT) scan was suggestive of obstructive hydrocephalus with a round spherical mass lesion in the pineal region. Clinical diagnosis of traumatic brain injury with incidental vascular malformation was made. He succumbed to his condition twelve hours into admission.
Autopsy findings: At autopsy, the brain was enlarged with bilaterally symmetrical cerebral hemispheres. There was a fusiform aneurysmal dilatation of the left vein of Galen measuring 3.5cm in length, causing a depression in the inferior surface of the temporal region of the left cerebral hemisphere. Both cerebellar tonsils were prominent. Coronal sections through the left cerebral hemisphere showed expansion of white matter with a markedly dilated lateral ventricle. Focal areas of contusional hemorrhages within grey and white mater of the cerebral hemispheres were seen.
Conclusion: Vein of Galen aneurysms may appear relatively asymptomatic with diagnosis dependent on imaging or a post-mortem examination.