We report a case of a 23 year-old Malay man who was admitted after a generalized tonic-clonic seizure. He had a second seizure in the emergency room. We discuss the diagnosis and treatment of the origin of the seizures. Case report A 23 year-old Malay man was admitted after a generalized tonic-clonic seizure. He had a second seizure in the emergency room. A known infrequent migraineur, he complained of severe dull occipital headaches of recent onset, different from his usual migraines. He denied head injury. Clinical examination was unremarkable. CT brain was significant for hemorrhage in the left frontal lobe (Figure 1A). In view of the absence of previous history of seizures, head trauma or cerebrovascular risks, as well as the presence of new-onset severe headaches, MRI brain was performed, showing infarcts in both frontal lobes, with hemorrhage in the left anterior frontal lobe (Figure 1B & C). Magnetic resonance venogram (MRV showed filling defects in the superior sagittal (Figures 1E-F and Video) and left lateral venous sinuses (Figure 1D), consistent with the diagnosis of cerebrovenous thrombosis (CVT). He was given phenytoin, anticoagulated with intravenous heparin, and later discharged with oral warfarin for 6 months. He remained well. Procoagulant and autoimmune screens were negative, as was CT scan of the sinuses.
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