Abstract
BACKGROUND: Deep cerebral venous thrombosis (DCVT) is exceedingly rare in isolation in the setting of trauma. Repercussions from delayed or absent treatment are associated with permanent neurological deficits and high rates of mortality. OBSERVATIONS: A 19-year-old male presented with headache and lethargy following a motor vehicle accident 4 days prior. CT findings were concerning for DCVT, which was confirmed on CT venogram. MRI showed venous congestion of the bilateral thalami, likely secondary to outflow obstruction. The patient's symptoms improved following anticoagulation therapy. LESSONS: This case represents the first documented case of isolated traumatic bilateral DCVT without a preexisting hypercoagulable state or associated mass lesion. Dedicated venous imaging should be obtained in high-impact traumatic brain injury when noncontrasted imaging studies are inconclusive and clinical symptoms indicate further investigation is needed. https://thejns.org/doi/10.3171/CASE25192.