Background: Despite being a rare condition, Cerebral venous thrombosis (CVT) is a serious event that predominantly affects young female adults, with diverse etiologies including systemic and localized risk factors. Patients present with focal neurological deficits and symptoms of increased intracranial pressure such as recurrent headaches and papilledema.   Prompt diagnosis and management are crucial to reducing morbidity and mortality risk. We present an unusual case of recurrent CVT in a female with no identifiable risk factors, highlighting the complexities in diagnosis and management.

Case Presentation: A 37-year-old previously healthy woman presented with recurrent CVT episodes despite initial successful anticoagulation therapy. The second episode resulted in drastic neurological deterioration including a large hemorrhagic cerebral infarction, necessitating urgent intervention and a decompressive craniotomy. Despite complications, the patient showed gradual improvement with continuous rehabilitation.

Discussion: CVT presents diagnostic challenges due to its diverse clinical manifestations and rarity. The vagueness of symptoms makes neuroimaging the investigation's cornerstone in promptly establishing a diagnosis. Although Low-Molecular-Weight Heparin (LMWH) has proven to be superior in the treatment of CVT, a significant number of patients still experience increased morbidity and recurrence rates. The recurrence of CVT showcases the need for vigilant monitoring and individualized management strategies. Conclusion: This case underscores the importance of comprehensive evaluation and long-term monitoring in CVT patients, particularly in cases of recurrence without apparent risk factors. Further research is needed to elucidate underlying mechanisms and optimize management strategies for such intricate cases.

Kholod Haj has completed her MBBS from University of Sharjah with a level of excellence. She is currently a medical intern at EHS. She has 2 publications with 4 other projects awaiting publication.