Imaging findings of an isolated deep cerebral venous thrombosis in the absence of superficial sinus thrombosis

Thrombosis of the deep cerebral venous system in the absence of superficial sinus thrombosis is a very rare disease. The clinical and radiological findings can be diagnostically challenging due to the subtle appearances on computed tomography (CT) scan. Magnetic resonance imaging (MRI) examination is a preferred imaging modality to complement the CT findings for an accurate diagnosis of venous sinus thrombosis. We present a case of this unusual condition which present as unilateral thalamic lesion on CT scan and the role of contrast enhanced MRI with fast spoiled gradient echo (FSPGR) sequence and 3D reconstruction which led to the diagnosis of thrombosis in the deep cerebral venous system. Neurology Asia 2015; 20(2) : 191 – 195 Address correspondence to: Dr Sabrilhakim Sidek, Medical Imaging Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000 Selangor, Malaysia. Tel: +603-61265338 Fax: +603-61265164, Email: [email protected], [email protected] INTRODUCTION Thrombosis of the deep cerebral venous system presenting with bilateral thalamic infarction or oedema in the absence of superficial sinus thrombosis is a rare manifestation. The clinical and radiological findings can be diagnostically challenging due to the subtle appearances on brain imaging. We report a case of this unusual condition which present as a mass-like lesion on unenhanced CT scan and the role of contrast enhanced magnetic resonance imaging (MRI) with fast spoiled gradient echo (FSPGR) sequence and 3D reconstruction to confirm the presence of thrombosis in the deep cerebral venous system.