Bithalamic infarction secondary to venous thrombosis - lupus anticoagulant

Case contributed by Xin Wu


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 restricted 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 filling defects in the deep venous drainage system and left transverse and sigmoid sinuses.

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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