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NEUROLOGY 2009;73:e57
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching NeuroImages: Reversible bilateral thalamic lesions in vein of Galen thrombosis

Rou-Chen Jee, MD and Sheng-Huang Lin, MD, MSc

From the Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.

Address correspondence and reprint requests to Dr. Sheng-Huang Lin, Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, No. 707, Sec. 3, Chung-Yang Rd., Hualien City, Hualien County 970, Taiwan, Republic of China shlin355{at}gmail.com

A 51-year-old woman was admitted with 2 days of progressive drowsiness and bradyphrenia. On examination, she had blood pressure of 125/75 mm Hg and a pulse of 68 beats/minute. She aroused to verbal stimuli, and her answers were correct but slow. There was no focal weakness or numbness, and reflexes were normal. Brain MRI revealed lesions in bilateral thalami and right caudate nucleus (figure, A) and vein of Galen thrombosis (figure, B). There was no evidence of dehydration, coagulopathy, autoimmune dysfunction, or infection. She recovered completely on heparin. Follow-up brain images were normal (figure, C and D). Early detection and treatment of deep cerebral venous thrombosis lowers the risk of permanent neurologic deficits.1,2


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  		Figure MRI findings in vein of Galen thrombosis

T2-weighted MRI (A) revealed high-signal lesions in bilateral thalami and right caudate nucleus. Magnetic resonance venography (B) showed thrombus formation in vein of Galen (arrow). After treatment, the lesions of bilateral thalami and right caudate nucleus disappeared (C), and the vein of Galen was patent (D).

 

Disclosure: The authors report no disclosures.


   REFERENCES
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 REFERENCES
 

  1. Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol 2000;247:252–258.[Medline]
  2. Wieshmann NH, Amin S, Hodgson R. A case of unilateral thalamic hemorrhagic infarction as a result of the vein of Galen and straight sinus thrombosis. J Stroke Cerebrovasc Dis 2009;18:28–31.[Medline]




This Article
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