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A 37-year-old man presented with headache. Brain vessel wall magnetic resonance imaging revealed a left temporal vascular ectasia with heterogeneous flow (Figure 1). Four-dimensional time-resolved magnetic resonance angiography (4DMRA) showed the lesion being progressively filled by contrast during the venous phase, with no arterial feeders (Figure 2 and Video). Isolated intracranial varix is a focal dilatation of a vein, without neural tissue or other vessels anomalies1. Its main differential diagnoses are meningioma and arteriovenous fistula2. Vessel wall imaging and 4DMRA can appropriately show the internal flow, absence of arterial components and progressive filling, during the venous phase, confirming the diagnosis and avoiding unnecessary surgery.

Intracranial isolated varix mimicking a meningioma: the relevance of modern MRI techniques for reliable diagnosis