The patient presented with altered mental status and was found to have patchy signal abnormality within the bilateral thalami, and high density within the deep venous drainage system. These findings were confirmed to reflect hemorrhagic bithalamic infarcts related to venous thrombosis on MRI. The venous thrombosis was confirmed by 3D postcontrast imaging as well as phase contrast MRV.

The patient was found on further medical workup to be positive for lupus anticoagulant antibody, which contributes to his hypercoagulable state.