Uncommon Yet Critical: A Case Report of Bilateral Haemorrhagic Thalamic Infarction in a Febrile Infant

Background: Cerebral venous thrombosis (CVT) is a rare form of stroke in infants and young children, with multifactorial causation and a poor prognosis. Bilateral haemorrhagic thalamic infarction secondary to deep CVT is an extremely rare presentation. Case report: We report the case of a 12-month-old infant with bilateral haemorrhagic thalamic infarction secondary to deep CVT, presenting with fever and seizures. The infant was initially diagnosed with acute meningoencephalitis of viral aetiology and treated accordingly. However, the patient had a sudden clinical deterioration. Neuroimaging revealed deep CVT with bilateral haemorrhagic thalamic infarction. Anticoagulant therapy in conjunction with physiotherapy was initiated and the infant gradually improved and was discharged. Conclusion: CVT is a rare form of stroke in infants and young children, with multifactorial causation and poor prognosis. Our case highlights the importance of careful evaluation of cerebral venous drainage on routine neuroimaging in infants with fever and seizures, especially in those who do not respond to standard treatment for meningoencephalitis. Synopsis: Here we report a unique and challenging case of deep cerebral venous thrombosis with haemorrhagic infarction of bilateral thalami mimicking viral encephalitis in an infant with acute febrile encephalopathy.