Thalamostriate venous infarction with antiphospholipid syndrome and SLE

Twenty-five-year-old with SLE and deep venous infarction.

At presentation, diffusion-weighted image (A) shows white matter ischemia in left centrum semiovale. FLAIR image (B) demonstrates focal signal abnormality in left caudal head (arrow), and T2*-weighted gradient-recalled echo (C) shows punctate hypointensity (arrowhead) attributed to focal venous thrombus.

Three days later, repeat MRI shows increased signal in left caudate head and mesial thalamus on FLAIR image (D) and petechial hemorrhage (thick arrow) in caudate nucleus and anterior thalamus on T2*-weighted gradient-recalled echo (E). On postcontrast T1-weighted image (F), there is a lack of enhancement in left thalamostriate and internal cerebral veins, consistent with thrombosis.