“Pulvinar Sign”

“Pulvinar Sign”

Karen L. Salzman, MD



  • Creutzfeldt-Jakob Disease (CJD)

  • Creutzfeldt-Jakob Disease, Variant (vCJD)

Less Common

  • Fabry Disease

  • Thalamic Infarct (Mimic)

  • Neoplasms (Mimic)

  • ADEM (Mimic)

Rare but Important

  • Periventricular Leukomalacia

  • Status Epilepticus


Key Differential Diagnosis Issues

  • “Pulvinar sign”: T2 hyperintensity in bilateral pulvinar, most sensitive for vCJD

  • T1 hyperintensity in pulvinar also called “pulvinar sign” (Fabry disease)

Helpful Clues for Common Diagnoses

  • Creutzfeldt-Jakob Disease (CJD)

    • Rapidly progressive, fatal neurodegenerative disease

    • Prion protein accumulates in neurons

    • 85% of cases sporadic; 15% genetic or familial

    • Infectious/iatrogenic cases, including vCJD, < 1%

    • ↑ T2 in basal ganglia (BG), thalamus, cortex

    • FLAIR & DWI MR most sensitive

  • Creutzfeldt-Jakob Disease, Variant (vCJD)

    • Bilateral T2 pulvinar hyperintensity

    • ± ↑ T2 dorsomedial thalami, periaqueductal gray, caudate nuclei

Helpful Clues for Less Common Diagnoses

  • Fabry Disease

    • Multisystem X-linked disorder with renal & cardiac dysfunction and stroke

    • T1 hyperintensity in bilateral pulvinar

    • CT may show mineralization in pulvinar

    • May see ischemia, white matter (WM) lesions, & vertebrobasilar dolichoectasia

  • Thalamic Infarct (Mimic)

    • Artery of Percheron infarct & internal vein thrombosis: Bilateral T2 hyperintensity

    • HIE may affect only deep gray nuclei

    • DWI bright in acute setting

  • Neoplasms (Mimic)

    • Lymphoma or astrocytoma may cause bilateral thalamic T2 hyperintensity

  • ADEM (Mimic)

    • T2 hyperintensity in bilateral thalami

    • WM lesions typically also present

Helpful Clues for Rare Diagnoses

Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on “Pulvinar Sign”

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