Bithalamic infarction secondary to venous thrombosis (lupus anticoagulant)

Case contributed by Dr Xin Wu

Presentation

Progressive altered mental status

Patient Data

Age: 50 years
Gender: Male

CT demonstrates patchy hypodensity in the bilateral thalami, as well as hyperdensity in the bilateral internal cerebral veins, vein of Galen, and left transverse sinus.

MRI demonstrates patchy reduced diffusion and susceptibility signal intensity in the bilateral thalami, and 3D postcontrast images demonstrate thrombi within vein of Galen, torcula, and left transverse/sigmoid sinus. MRV demonstrates nonopacification of the deep venous drainage system.

Case Discussion

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.

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Case Information

rID: 51300
Case created: 10th Feb 2017
Last edited: 15th Feb 2017
Inclusion in quiz mode: Excluded

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