Teaching NeuroImages: A look beneath the surface in a “typical” thalamic hemorrhage

Imaging beyond routine CT in intracerebral hemor-rhage (ICH) is most likely to reveal underlying pa-thology in patients with lobar ICH, younger age, or no history of hypertension.1 In hypertensive individ-uals with typical ganglionic ICH, additional imaging is usually not considered.2 A 75-year-old patient with hypertension was admitted with acute onset of hemiparesis. CT revealed thalamic ICH (figure, A). Within a study, the patient underwent additional MRI (figure, B), which disclosed sinus thrombosis. Typical symptoms of sinus thrombosis (headache, papilledema) were absent. After extensive diagnostic workup, infection-related exsiccosis was assumed causative. The patient received anticoagulation. In this case, MRI not indicated clinically had thera-peutic implications. REFERENCES 1. Delgado Almandoz JE, Schaefer PW, Forero NP, et al. Diagnostic accuracy and yield of multidetector CT angiog-raphy in the evaluation of spontaneous intraparenchymal cerebral hemorrhage. AJNR Am J Neuroradiol 2009;30