Abstract Bilateral infarctions of the thalamus account for only a small fraction of ischemic strokes and carry a poor prognosis. These infarcts rarely have a venous etiology. A case secondary to straight sinus thrombosis is presented. Difficulties in considering the diagnosis and its radiological appearances are discussed. A simple imaging pathway including computed tomographic angiography and magnetic resonance imaging including a susceptibility-weighted sequence is presented in order to facilitate determination of the exact etiology in order to optimize therapy accordingly.