Elsevier

Clinical Imaging

Volume 73, May 2021, Pages 23-25
Clinical Imaging

Thalamic venous infarction from trauma mimicking a glioma

https://doi.org/10.1016/j.clinimag.2020.11.045Get rights and content

Highlights

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    Traumatic brain injury is common among young adults.

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    Venous structures are prone to injury in traumatic brain injuries.

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    Venous infarcts and injuries can rarely manifest as mass lesions.

Abstract

Traumatic brain injuries (TBI) are commonly associated with motor vehicle accidents. Neuroimaging plays a crucial role in the initial management of TBIs. We present a case of a TBI related to a motor vehicle accident in an 18-year-old woman. Initial brain imaging revealed significant traumatic injuries and an enhancing mass, without restricted diffusion, in the thalamus favored to be a thalamic glioma. Subsequent imaging revealed resolution of enhancement of the thalamic lesion and reduction in size. On review of the original imaging, it was determined that the thalamic lesion was related to a tear and partial thrombosis of a large thalamic vein resulting in infarction and hemorrhage.

Introduction

Traumatic brain injury (TBI) is a significant cause of morbidity and mortality for younger adults.1 Diffuse axonal injury (DAI) is a severe form of TBI which is most commonly caused by motor vehicle accidents.2 MRI plays a crucial role in delineating the extent of injury in TBI and helps prognosticate.3 Veins are susceptible to direct damage in TBI due to the lack of musculature in the vessel walls. They are also susceptible to secondary injury from elevated intracranial pressure related to TBI.4 The thalamus plays a key role in consciousness, and thalamic involvement has been described in diffuse axonal injury. In one study, lesions in the thalamus were present in 40% of patients with post-traumatic persistent vegetative state.5

Section snippets

Clinical case

An 18-year-old woman was an unrestrained passenger in a motor vehicle accident. Her initial Glasgow Coma Scale was 3. There was evidence of liver and splenic lacerations with a small amount of intraperitoneal blood. Non-contrast head CT revealed an enlarged hypodense left thalamic lesion with surrounding intraparenchymal hemorrhage with ventricular extension and early hydrocephalus (Fig. 1A). There were also facial fractures present. CT angiogram of the head and neck revealed normal

Discussion

Venous infarctions related to cerebral venous thrombosis have been rarely found to mimic gliomas.6 Cerebral venous thrombosis can occur in traumatic brain injuries and are associated with fractures extending into the dural venous sinus or jugular bulb.7 In our case, it was felt that the thalamic lesion was due to a tear and thrombosis of a thalamic vein related to the TBI which initially presented as venous congestion and hemorrhage that progressed to infarction. The lack of restricted

Grant support

None.

Declaration of competing interest

None.

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