Acute Cerebral Venous Thrombosis of the Vein of Trolard with Parietal Haemorrhage and Protein S Deficiency Following Viral Meningoencephalitis: A Case Report

Abstract

Cerebral venous thrombosis (CVT) involving cortical veins, such as the vein of Trolard, is a rare and diagnostically challenging entity. We report a young man who developed a first generalized seizure after two weeks of headache and behavioural change, occurring two weeks after hospitalisation for viral meningoencephalitis. MR venography confirmed acute thrombosis of the left vein of Trolard with an associated left parietal haematoma; thrombophilia screening revealed reduced Protein S activity (56%). He improved with anticoagulation and antiepileptic therapy despite haemorrhagic transformation, and was discharged with a plan to repeat thrombophilia testing after three months. This case highlights the role of MR venography and targeted thrombophilia screening in young patients with unexplained CVT, particularly after recent CNS infection.