A 38-year-old man presented with seizures and was diagnosed with cortical venous thrombosis. He had multiple risk factors including diabetes, hyperhomocysteinemia, and dyslipidemia. He was treated with anticoagulation but continued having seizures. Imaging later revealed a venous infarct. His symptoms gradually improved with treatment but he was discharged with some residual neurological deficits. Cortical venous thrombosis can be challenging to diagnose but outcomes have improved with prompt diagnosis and treatment. Hyperhomocysteinemia is an increasingly recognized risk factor.