The Pulvinar Sign

The Pulvinar sign can refer to: T2 hyperintensity in the posterior thalamic nuclei (the pulvinar). It is most sensitive for variant Creutzfeldt-Jakob disease. A positive pulvinar sign can be called when the pulvinar are hyperintense to the anterior putamina.

Differential considerations include bilateral thalamic infarctions, perinatal ischemic injury, deposition of iron or copper, and neoplasm (e.g., lymphoma, glioma).

T1 hyperintensity exclusively in the putamina has been described in patients with Fabry disease. It can also be seen in patients with metabolic disorders (eg, Krabbe or Tay-Sachs disease), central nervous system infections, or after chemoradiation.

Images of the pulvinar sign can be found at AJNR and AJR.

References

• Collie DA, Summers DM, Sellar RJ, Ironside JW, Cooper S, Zeidler M, Knight R, Will RG. Diagnosing variant Creutzfeldt-Jakob disease with the pulvinar sign: MR imaging findings in 86 neuropathologically confirmed cases. AJNR Am J Neuroradiol. 2003 Sep;24(8):1560-9.
• Molloy S, O'Laoide R, Brett F, Farrell M. The "Pulvinar" sign in variant Creutzfeldt-Jakob disease. AJR Am J Roentgenol. 2000 Aug;175(2):555-6.
• Cocozza S, Russo C, Pisani A, et al. Redefining the Pulvinar Sign in Fabry Disease. AJNR Am J Neuroradiol. 2017 Oct 19.