Bilateral carotid and vertebral rete mirabile with vein of Galen aneurysmal malformation: an unreported association

BMJ Case Rep. 2014 Nov 20:2014:bcr2014011349. doi: 10.1136/bcr-2014-011349.


Rete mirabile is a fine meshwork of anastomosing vessels that replace the parent artery. A 30-year-old woman complained of slurring of speech, right eye proptosis, recurrent vomiting, and loss of bladder and bowel control, followed by drowsiness lasting 30-40 min, for the past 6 months. On cross sectional imaging and angiography, the patient was found to have a vein of Galen aneurysmal malformation, with bilateral carotid and vertebral rete mirabile. The patient was offered both endovascular and open surgical options but she refused any form of surgical treatment and opted for conservative management. At the 6 month follow-up, she continued to have occasional episodes of headache and vomiting but was otherwise normal. We describe the clinical, cross sectional, and angiographic features of this patient. A comparison with other patients with bilateral carotid and vertebral rete mirabile is also reported.

Keywords: Arteriovenous Malformation; Brain; Fistula; Vessel Wall.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Carotid Artery, Internal / diagnostic imaging*
  • Cerebral Angiography
  • Cerebral Veins / diagnostic imaging*
  • Female
  • Humans
  • Vein of Galen Malformations / complications*
  • Vein of Galen Malformations / diagnostic imaging
  • Vertebral Artery / diagnostic imaging*

Supplementary concepts

  • Vein of Galen aneurysm