Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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February 18, 2013
Subacute Right Thalamic Infarction
- Subacute infarcts can demonstrate contrast enhancement, starting within a few days and persisting up to a few months. Parenchymal enhancement may be intense and can cause diagnostic uncertainty in cases in which the clinical history is obscure.
- Thalamic infarcts may present with acute onset of dementia, more commonly seen with bilateral thalamic infarcts but which can also occur with unilateral infarction.
- Key Diagnostic Features: Subacute infarction shows T1 and T2 prolongation with lack of restricted diffusion. Contrast enhancement is seen from day 2 and can persist up to 4-6 weeks. There is lack of perilesional edema and mass effect on adjacent structures. MR spectroscopy usually shows elevated lactate and reduced choline, creatine, and NAA within the infarct.
- DDx: Tuberculoma; glioma; lymphoma
- Rx: Stroke treatment; antiplatelet drugs
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