Bilateral Thalamic Infarction Secondary to Deep Cerebral Venous Thrombosis: A Diagnostic Challenge Associated With Hormonal Therapy.

Deep cerebral venous thrombosis (DCVT) represents an uncommon and potentially devastating variant of venous cerebrovascular disease, characterized by the occlusion of the Galenic system and the straight sinus. This pathology disrupts the drainage of critical diencephalic structures, resulting in venous congestion that radiologically manifests as symmetrical bilateral thalamic edema or infarction. We report the case of a 56-year-old female with a history of chronic oral estradiol valerate and levonorgestrel use for hormone replacement therapy, who presented with acute neurological impairment, including deep somnolence and temporospatial disorientation. Laboratory tests revealed elevated D-dimer (2020 ng/ml), and neuroimaging confirmed the absence of flow in the deep venous sinuses with bilateral thalamic involvement. The patient was treated with therapeutic doses of enoxaparin, showing remarkable clinical improvement and regaining full orientation within eight days. DCVT must be considered a primary differential diagnosis in patients with impaired consciousness and symmetrical bilateral thalamic lesions, as early recognition of procoagulant risk factors and immediate anticoagulation are decisive in preventing permanent sequelae.