A 7 day old girl presented with a one day history of decreased feeding, lethargy, and shaking of her extremities. She was born at term by normal vaginal delivery. She did not have a fever and there were no maternal risk factors for sepsis. She was hypotonic and minimally responsive on examination, with no signs of focal neurology.

Urea, electrolytes, calcium, and glucose values were normal. She was started empirically on intravenous antibiotics and aciclovir after full septic screen. She was ventilated and given an infusion of midazolam because her generalised clonic seizures with apnoea failed to respond to intravenous phenobarbital. Her seizures finally responded and she was extubated after 24 hours; she was maintained on regular phenobarbital with good effect.

Urgent neuroimaging (figs 1⇓ and 2⇓) was arranged because of her acute presentation with seizures and a history of deep vein thrombosis and pulmonary embolism in her mother and maternal uncle.