Bilateral thalamic infarction secondary to internal cerebral vein thrombosis in a postpartum patient: a rare case report

Introduction and Importance: Bilateral thalamic infarction is an uncommon manifestation of cerebral venous thrombosis (CVT), particularly when caused by thrombosis of the internal cerebral veins. Venous infarctions affecting the bilateral thalami are exceptionally rare and often present with nonspecific clinical features, making early diagnosis challenging. Case presentation: Here we present a-28-year-old postpartum female who presented to the emergency room with severe headache, convulsions, and altered mental status, following 1-week of progressive headache and blurred vision. She had recently undergone uncomplicated spontaneous vaginal delivery. Neurological examination revealed a stuporous mental state and bilateral grade II papilledema. Initial noncontrast CT showed bilateral thalamic hypodensities, while magnetic resonance imaging (MRI) confirming acute infarction in the bilateral thalami. Cerebral magnetic resonance angiography (MRA) showed no arterial abnormality, where as MR venogram revealed thrombosis of internal cerebral vein, confirming CVT as the underlying etiology. The patient was managed in the ICU with therapeutic anticoagulation using low-molecular-weight heparin (LMWH), levetiracetam for seizure prophylaxis, and transitioned to warfarin for long-term anticoagulation treatment. Her clinical condition significantly improved, and she was discharged after 2 weeks of hospitalization. At 6-month follow-up, she remained asymptomatic and functionally independent. Clinical discussion: Bilateral thalamic infarction resulting from internal cerebral vein thrombosis is exceptionally rare. The internal cerebral veins drain deep brain structures, including the thalami, and their occlusion can lead to symmetrical infarction in these regions. Because bilateral thalamic infarcts are more commonly associated with arterial causes; diagnosis in venous infarction can be challenging and requires a high index of suspicion. Conclusion This case highlights the importance of early diagnosis and management of cerebral venous thrombosis to prevent complications. A high index of suspicion is needed for CVT in cases of bilateral thalamic infarction specially in patient with risk factors for venous thromboembolism like postpartum state.