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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May 23, 2024
Choroid Plexus Infarction
- Background:
- Isolated ischemia of the choroid plexi is rare due to rich vascular supply and anastomosis of anterior and posterior choroidal arteries. It may result from ischemia in the distribution of the medial posterior choroidal artery. Venous infarcts may occur in occlusions of superior and inferior choroidal veins that are tributaries of internal cerebral and basal veins. Despite the elaborate function of the choroid plexus, pathologic derangements of this structure are of rare clinical significance.
- Clinical Presentation:
- Without any obvious symptoms, localized choroid plexus infarction most likely has a very small impact on CSF control.
- Key Diagnostic Features:
- Unilateral or bilateral enlargement of the choroid plexus associated with hemorrhagic components better seen on SWI/GRE in the context of deep cerebral vein thrombosis
- DWI: diffusion restriction; usually seen associated with other posterior cerebral artery territory infarcts
- Spontaneous T1 hyperintensity consistent with hemorrhage; associated thalamic venous infarcts may be present
- Differential Diagnosis:
- Choroid plexitis/ventriculitis: Bilateral symmetric enlargement of the choroid plexus in an infectious context (encephalitis, meningitis, or ventriculitis). May show diffusion restriction.
- Diffuse villous hyperplasia: Diffuse enlargement and homogeneous enhancement of the choroid plexus, sometimes associated with hydrocephalus; no hemorrhage.
- Choroid plexus hemosiderosis: Very low signal of the choroid plexus on SWI with prior history of transfusion iron overload; normal size.
- Xanthogranulomata: Bilateral cystic foci with diffusion restriction, but incidental findings
- Treatment:
- Venous infarction of the choroid plexus may be asymptomatic, but sometimes can present with CSF abnormalities such as hydrocephalus. In patients with documented sinovenous thrombosis, rapid anticoagulation therapy is required.
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