Unilateral Thalamic Venous Infarction in an Infant

Case Reports in Radiology
15 Mar, 2019 ,

A 15-month-old male came c/o sudden onset of right arm and leg weakness that had started 3 hours prior to admission. X rays ruled out presence of trauma. CT without contrast revealed hypodensity of the left thalamus. MR venography confirmed lack of flow-related signal throughout the deep venous system. The patient was treated with Anticoagulation therapy and IV hydration. 

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A 15-month-old male presented to the Emergency Department (ED) with sudden onset of right arm and leg weakness beginning 3 hours prior to admission. His clinical history included a viral illness 5 days prior to admission, with malaise, fever, vomiting, and diarrhea. Early in the course of that illness he was seen by a pediatrician who noted mild dehydration, and suggested oral rehydration and antipyretics. He was otherwise healthy, with up-to-date immunizations.

On arrival to the ED physical exam revealed flaccidity in right upper and lower extremities. X-rays of right upper extremity obtained to rule out trauma were negative. Lab results showed microcytic anemia with hemoglobin of 6 g/dL, and thrombocytosis, with a platelet count of 512,000. The remaining labs were normal. Computed tomography (CT) of the head without contrast showed hypodensity of the left thalamus. In addition, high attenuation was noted throughout the bilateral deep venous system, compatible with acute DCVT.

Anticoagulation therapy and IV hydration were initiated immediately after radiologic findings were discussed with the ED physician. The patient was transferred to the Intensive Care Unit of our tertiary pediatric hospital. Magnetic resonance imaging (MRI) of the brain demonstrated restricted diffusion in the central aspect of the thalamus, surrounded by vasogenic edema, compatible with acute venous infarction. No other parenchymal lesion was detected. Signal changes within the deep venous system were compatible with acute intraluminal thrombus. MR venography confirmed lack of flow-related signal throughout the deep venous system.