Presentation
Dizzy.
Patient Data
Non-contrast study demonstrates calcification in the globus pallidus and posterior thalamus. The differential of thalamic hemorrhage was given, even though A) it appears like calcification and B) there is no edema surrounding the calcification which would be expected even if acute.
MRI brain (next day)
Calcification of the right thalamus and globus pallidus is associated with a branching draining vein (into the basal vein of Rosenthal at the level of the right superior colliculus) in keeping with a development venous anomaly. This is difficult to appreciate on DSA (not shown), which excludes a shunting AVM/dAVF. Prominent chronic small vessel ischemic change noted. No focal mass or collection.
Conclusion: The CT and MRI abnormalities represent asymmetric mineralization/calcification. There is a known associated with a developmental venous anomaly.
Case Discussion
In this case, the absence of any edema surrounding the thalamic hyperdensity is a clue that there is nothing acute going on.
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