Thrombosis of the Vein of Trolard: An Atypical Presentation of Protein C Deficiency

Cerebral venous thrombosis refers to complete or partial occlusion of the cerebral sinus/es or the feeding cortical veins, resulting in secondary effects of vascular congestion and focal or generalized neurological deficits. One of the important causes of venous thromboembolism is inherited thrombophilia. Our case is of a 34-year-old male with no previous comorbidity who presented to the emergency department with complaints of sudden onset left-sided weakness, seizures, and loss of consciousness for one day. Thrombosis of the vein of Trolard was diagnosed based on magnetic resonance venography (MRV) film. His MRI with MRV revealed an attenuated caliber of the vein of Trolard along with abnormal signal intensity in the right fronto-parietal region and the right falcine location. He was managed with intravenous medication, including levetiracetam and topiramate. Once the diagnosis was established, he was commenced on subcutaneous Enoxaparin. Consequently, his GCS improved from 6/15 to 15/15 within the first 24 hours, and he could move his limbs on the day of discharge without any significant disability.