International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198 Int J Case Rep Images 2019;10:101021Z01MA2019. www.ijcasereportsandimages.com Amran et al. 1 CLINICAL IMAGE PEER REVIEWED | OPEN ACCESS CT-scan imaging of a puerpuralis woman with cerebral infarction due to straight sinus thrombosis mimicking cerebral abscess in bilateral thalamus Muhammad Yunus Amran, Lisa Tenriesa Muslich CASE REPORT A 24-year-old woman was admitted to the emergency room (ER) with loss of consciousness accompanied by restlessness and voiceless from two days prior to admission. History of nausea, five times vomiting and weakness prior to loss of consciousness was obtained from patient’s family (husband and mother). Patient also had a history of fever three days before the admission which subsided after consuming acetaminophen and vitamins and occurred all over again not long after. Patient was in the period of postpartum day 37th, normal delivery with perineal stitches, assisted by a midwife in Community Health Sub-center. There was no long history of cough, trauma, or history of fever from second to tenth day after delivery. The patient looked pale shortly after delivery, and complained of pain in the back of her head. General examination showed blood pressure 140/90 mmHg, regular and strong heart rate with 92 beats per minute, 20 times per minute thoraco-abdominal type of breathing, and 37.1°C temperature. No pallor, jaundice Muhammad Yunus Amran 1 , Lisa Tenriesa Muslich 2 Affiliations: 1 Clinical Associate Professor and Lecturer, De- partment of Neurology, Medical Faculty of Hasanuddin Uni- versity, Dr. WahidinSudirohusodo General Hospital, and Hasanuddin University Teaching Hospital, Jl. PerintisKe- merdekaan KM 11, Makassar, South Sulawesi, Indonesia; 2 Clinical Assistant Professor and Lecturer, Clinical Microbiol- ogy Department, Medical Faculty of Hasanuddin University, Hasanuddin University Teaching Hospital, Makassar, South Sulawesi, Indonesia. Corresponding Author: Muhammad Yunus Amran, M.D., Ph.D., FIPM, Neurologist, Lecturer and Clinical Assistant Professor, Department of Neurology, Medical Faculty of Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital, and Hasanuddin University Teaching Hospital, Jl. PerintisKemerdekaan KM 11, Makassar, 90245, Indonesia; Email: yunusamran10@gmail.com Received: 24 February 2019 Accepted: 22 March 2019 Published: 25 April 2019 nor cyanosis was observed. The neurological examination included Glassglow Coma Scale (GCS) score that was 7/15 (E2M4V1). The cortical function was difficult to assess. The meningeal signs that included nuchal rigidity and Kernig’s sign were both positive; cranial nerves were within normal limits; abdominal wall reflexes, sensory function, as well as autonomic function such as urination and defecation were within normal limits. The movement and strength in motoric functions were difficult to assess and showed no lateralization. The muscle tone and physiological reflexes were increased and pathological reflexes were positive in all extremities. Laboratory examination showed an increased number of white blood cells (16.6x10 3 /mm 3 ) while other results of laboratory tests such as complete blood count, random blood glucose, urea, creatinin, liver functions, and blood electrolytes were within normal limits. Head CT scan (Figure 1) showed a hyperdense lesion filling the posterior interhemispheric fissure, basal ganglia and right thalamic region which was suggestive of encephalitis with subarachnoid hemorrhage on the posterior interhemispheric fissure. The results of cerebral CT arteriography and venography showed a hypodense lesion (33.93 HU) on bilateral thalamus particularly in the right side with minimal enhancement ring after injection of contrast. Moreover, there was also linear posterior interhemispheric hyperdense lesion in accordance with rectus sinus. Filling defects of the rectus Figure 1: Head CT Scan with contrast. Red arrows indicate hypodense lesion in the right bilateral thalamus area and green arrows show the hyperdense lesion due to the contrast of the interhemispheric fissure, with a thrombus in the sinus rectus.