Central venous sinus thrombosis presenting with generalized tonic-clonic seizures in a patient with no known risk factors

Central venous sinus thrombosis (CVST) is an uncommon etiology of stroke that predominantly affects women. Nonspecific symptoms include headache, seizure, focal neurologic findings, encephalopathy, and elevated intracranial pressure. We present a case of a previously healthy woman with a new onset seizure, whose only other complaint was weakness despite a normal neurological examination. Her head computed tomography (CT) showed an intraparenchymal hemorrhage of the left frontal lobe and signs of infarction of the right frontal lobe. Magnetic resonance imaging (MRI)/magnetic resonance venography (MRV) revealed a thrombosis in the superior sagittal and right transverse sinus. Further testing revealed a previously undiagnosed malignancy and a previously undiagnosed clotting disorder, both of which contributed to her hypercoagulability. Her case highlights the importance of keeping a high index of suspicion for CVST as examination and CT may be insufficient to make the diagnosis.