Magnetic resonance angiography in the diagnosis of deep cerebral venous thrombosis

Given the nonspecific and conflicting “indirect” signs and rare occurrence of the true “direct” signs on computed tomography (CT) and magnetic resonance imaging (MRI), conventional angiography has been the “gold standard” in the diagnosis of cerebral venous thrombosis. Visualization of the deep venous system by magnetic resonance angiography (MRA) suggests this modality may accurately demonstrate thrombosis at this level. We present a 34-year-old Down syndrome patient with deep cerebral venous thrombosis demonstrated by MRA who was initially misdiagnosed as a bithalamic glioma due to the similarity in the imaging characteristics of the two conditions. No direct evidence of venous thrombosis was present on CT or MRI. MRA was the sole noninvasive imaging modality to “directly” demonstrate venous thrombosis and is suggested in the evaluation of unexplained or atypical cerebral events that may represent deep cerebral venous thrombosis.