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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June 14, 2018
Choroid Plexus Infarction
- Background:
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The choroid plexus is a secretory tissue responsible for producing CSF in the brain.
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The blood supply to the choroid plexus comes from the anterior, lateral posterior, and medial posterior choroidal arteries. The rich collateral circulation helps protect them from focal ischemic events.
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Despite the role of the choroid plexus in CSF production, focal injuries usually have no clinical significance.
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- Clinical Presentation:
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Localized infarction of the choroid plexus probably has a negligible effect on CSF regulation, without any clinical manifestations.
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Clinical presentation depends on the location of the associated ischemic lesions.
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- Key Diagnostic Features:
- Unilateral diffusion restriction of the choroid plexus with evolution with time as expected for infarction
- The association of another infarction in the same vascular territory helps in the diagnosis.
- Differential Diagnoses:
- Cysts: follow CSF in all sequences
- Choroid plexus xanthogranuloma: variable signal characteristics depending on the mixture of lipid, fluid, and blood products; does not fully suppress on FLAIR; high signal on DWI, usually bilateral
- Intraventricular hemorrhage: incomplete CSF FLAIR signal suppression with signal dephasing on T2*/SWI; hematocrit fluid-fluid levels in the dependent portions of the ventricles (occipital horns)
- Pyogenic ventriculitis: layering debris in the occipital horns with marked restricted diffusion
- Treatment:
- Standard stroke management depending on the cause and location of the associated infarcts
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