14-year-old male presented to hospital with left hemi-sensory deficits since the previous night. Initial evaluation revealed altered mental status, hemiparesis, and cranial neuropathies (CN-III, V, VI, VII). He had intermittent fevers, headaches, and early morning vomiting for a month, along with otitis media and partially treated streptococcal pharyngitis per father. MRI revealed restricted diffusion in the right thalamus, midbrain, and cerebellum with diffuse leptomeningeal enhancement, suggestive of infectious cerebritis and vasculitis. MRV confirmed left transverse and straight sinus thrombosis. CSF opening pressure was markedly elevated (55 mmHg) with neutrophilic pleocytosis and protein >300 mg/dL, though cultures and viral panels remained negative. Despite broad-spectrum antimicrobials and antivirals, the patient’s deficits progressed, prompting EVD placement for ICP control and anticoagulation initiation. Over subsequent weeks, neuroimaging demonstrated evolution of infarcts without new hemorrhage, while clinical status eventually improved with corticosteroids, long-term anticoagulation, and rehabilitation.