PMC4989586_01
Brain CT shows bilateral pulvinar hypodensity and subacute hemorrhage within.
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The brain CT was then repeated and revealed bilateral pulvinar hypodensity and subacute hemorrhage within (Figure 1).
(a) Sagittal T1 MRI without contrast shows hyperintense vein of Galen and straight sinus; (b, c, d) T2 and fluid attenuation inversion recovery and flair; (e, f) MRI shows bilateral thalamic T2 hypersignal and edema with subacute hemorrhage; (g, h) diffusion-weighted MRI shows restricted diffusion; (i, j, k) susceptibility weighted imaging (SWI) MRI shows bilateral intrathalamic hemorrhage; and (l) time-of-flight (TOF) MRI shows patent basilar artery and posterior cerebral artery (PCA) bilaterally.
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Intrathalamic hemorrhage was also noted (Figure 2).
MRV shows patent dural venous sinuses with right transverse and sigmoid sinuses reduced calibers.
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Brain magnetic resonance venography (MRV) showed right transverse, and sigmoid sinuses reduced calibers with no corresponding cerebral lesions (Figure 3).
Positive pathergy test: postural rash on the right arm.
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Pathergy test was repeated again and showed a stark positivity (Figure 4).
(a,b) Flair, (c,d) T2, (e) SWI, (f) T1 MRI show no active lesions and chronic hemorrhage; (g, h) T1 MRI shows disappearance of hyperintense vein of Galen; and (i) follow-up MRV shows reduced calibers of right transverse and sigmoid sinuses along with patent remaining dural sinuses.
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Follow-up MRI and MRV were done and revealed no active lesions (Figure 5).