Internal Cerebral Vein Thrombus Mimicking Thalamic Neoplasm in a Child with Down Syndrome.
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INTRODUCTION: Thalamic strokes are uncommon in children and often arise from underlying conditions such as coagulopathy. Their clinical and radiological resemblance to neoplasms - with shared symptoms and overlapping MRI features - makes accurate diagnosis particularly challenging. CASE PRESENTATION: A 2-year-old boy with trisomy 21 (Down syndrome) presented with 5 days of altered mentation and fussiness, nausea, vomiting, and seizures. CT head demonstrated a right thalamic edematous lesion. MRI showed a lesion with imaging features suggestive of a thalamic neoplasm that was ultimately found to be an infarct secondary to right internal cerebral vein thrombus. The patient was treated with heparin and returned to his clinical baseline. CONCLUSION: Given their predisposition to coagulopathy, patients with Down syndrome require meticulous imaging evaluation. CT venogram can be an essential part of workup for this patient population.