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Images in Neurology |

Atypical Cerebral Venous Thrombosis Magnetic Resonance Imaging and Spectroscopy Features

Duško Kozić, PhD; Vesna Njagulj, MD; Jelena Ostojić, PhD; Slobodan Sekulić, PhD; Marija Žarkov, PhD
Arch Neurol. 2012;69(7):930-931. doi:10.1001/archneurol.2011.2542.
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A 17-year-old previously healthy girl had progressively worsening episodic pulsative headaches with vomiting over 1 week. Magnetic resonance imaging examination revealed the presence of an expansive left thalamic lesion (Figure 1A and B), while magnetic resonance spectroscopy detected decreased choline to creatine ratio (0.47) within the lesion, suggesting noninflammatory and non-neoplastic nature accompanied by increased lactate peak, consistent with the presence of anaerobic glycolisis (Figure 1C). T1-weighted images showed the presence of thrombus within the straight sinus and internal cerebral vein (Figure 1D). Results from additional tests revealed the presence of coagulopathy, consistent with antiphospholipid syndrome. The patient was not taking oral contraceptives. Administered anticoagulant treatment was associated with marked regression of the left thalamic venous infarct volume 12 days after initial magnetic resonance study (Figure 2). The patient was discharged with complete regression of symptoms and no abnormalities on neurologic examination.

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Figure 1. Brain magnetic resonance images. Flair (A) and T2-weighted (B) images show a tumefactive left thalamic venous infarct (arrows) associated with the presence of decreased choline to creatine ratio (0.47) on short-echo single-voxel magnetic resonance spectroscopy (C). D, The presence of the typical sign of straight sinus thrombosis on a T1-weighted sagittal image (arrow).

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Figure 2. Control brain magnetic resonance imaging examination performed 12 days later. Flair (A) and T2-weighted (B) images show marked posttreatment regression of the left thalamic venous infarct (arrows) and complete regression of the straight sinus thrombosis on T1-weighted sagittal image (C, arrow).

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