Angiography — Thalamic Hemorrhage Spot Sign

Good technique and Flat Panel imaging (DYNA) — we can now see things we knew should be there.  Like a “spot sign” from a hypertensive thalamic hemorrhage.  They are not always there as these usually thrombose over time and there is no treatment indication since rebleeding is extremely rare.  But, it is important to know about it and understand what’s happening.

Noncon CT typical thalamic hematoma with intraventricular extension

CTA shows no spot sign

Angio — GA, apnea, meticulous technique – do u see the spot?

DYNA — targeted reconstruction of the thalamic region — that’s what it takes to see it

VR — see it now?  Off the posteromedial choroidal artery