PMC6220396_01
Axial noncontrast CT at the level of basal ganglia. These scans demonstrate dense clot sign which show a dark area (yellow arrows) where the infarct of the left thalamus is located due to thrombosis of internal cerebral veins and straight sinus (red arrows).
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Computed tomography (CT) of the head without contrast showed hypodensity of the left thalamus (Figure 1). In addition, high attenuation was noted throughout the bilateral deep venous system, compatible with acute DCVT (Figure 1).
MRI obtained to confirm deep cerebral venous thrombosis and left thalamic infarction. DWI and ADC imaging ((a), (b), (g), and (h)) shows restricted diffusion in the anteromedial left thalamus without distinct territorial boundaries in relation to venous ischemia. T2 FLAIR hyperintensity ((c), (d), (i), and (j)) shows surrounding edema related to the infarction. GRE image (f) shows dark signal loss suggestive of petechial hemorrhage around the area of ischemia. GRE image (l) shows linear signal drop in the posteromedial surface of the left thalamus, highly suggestive of thrombus within a venous structure, likely part of the left internal cerebral vein.
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Magnetic resonance imaging (MRI) of the brain demonstrated restricted diffusion in the central aspect of the thalamus, surrounded by vasogenic edema, compatible with acute venous infarction (Figure 2). Signal changes within the deep venous system were compatible with acute intraluminal thrombus (Figure 2).
MRV was performed which showed a filling defect of straight sinus and internal cerebral veins (yellow arrow).
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MR venography confirmed lack of flow-related signal throughout the deep venous system (Figure 3).