Bilateral Vein of Trolard Thrombosis Presenting with Seizure and Minimal Deficits: A Rare Case Report

Cortical vein thrombosis (CVT) is a rare subtype of cerebral venous thrombosis characterized by a highly variable clinical and radiologic presentation, commonly leading to delayed diagnosis. We report a 64-year-old right-handed male who presented after being found unresponsive and was subsequently found to have bilateral thrombosis of the veins of Trolard. His clinical presentation was notable for seizure and National Institutes of Health Stroke Scale (NIHSS) score of 0. Initial computed tomography (CT) head without contrast scan demonstrated bilateral subtle cortical vein hyperdensity, while subsequent magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) confirmed bilateral cortical vein thrombosis with associated venous congestion and a small subarachnoid hemorrhage. The patient was treated with anticoagulation and antiseizure therapy with complete neurological recovery. This case emphasizes the importance of early venous imaging in patients presenting with seizures and minimal deficits, as cortical vein thrombosis may be overlooked, particularly in atypical presentations. The patient demonstrated a favorable clinical outcome with complete resolution of symptoms and a modified Rankin Scale (mRS) score of 0 at discharge.