PMC3970369_01
The patient with dysconjugate eye position.
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fig1
Yet, his gaze in the midline was dysconjugate with abduction weakness present bilaterally (Figure 1).
CT on admission. The white arrows show the hypodensities seen medial in the thalamus bilaterally.
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fig2
Due to the acute onset of dysarthria and oculomotor pathologies an urgent cerebral CT was performed revealing hypodense changes in the thalamus bilaterally (Figure 2).
CT perfusion on admission. Time-to-peak map (TTP, (a)) showing reduced time-to- peak and cerebral blood flow map (CBF, (b)) and cerebral blood volume map (CBV, (c)) showing increased relative cerebral blood flow and relative cerebral blood volume in thalamus bilaterally.
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fig3
A subsequent CT perfusion scan (CTP) revealed hyperperfusion in the same areas (Figure 3) whereas CT angiography of the posterior circulation vessels did not show any abnormalities.
MR at day 3 showing hyperintense changes in both thalami adjacent to the third ventricle on FLAIR series (a) and Gd-enhancement in the thalami (b) and in the mammillary bodies (c).
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fig4
These lesions exhibited slight gadolinium (Gd) contrast enhancement as did both mammillary bodies (Figure 4).