Cerebral Infarction in an HIV-Infected Patient with Combined Protein S and C Deficiency and a Patent Foramen Ovale

Tomomasa, Ran; Yamashiro, Kazuo; Tanaka, Ryota

doi:10.1016/j.jstrokecerebrovasdis.2013.04.019

Cited by 3 publications

(5 citation statements)

References 10 publications

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“…PC deficiency presenting as an ischemic lesion of left thalamus with bilateral occlusion of the internal carotid arteries was reported by Kikuta et al [34]. Similarly, a CT scan of a 35-year-old woman with right-sided weakness and fatigue revealed multiple low-density lesions in the cerebellar hemisphere and vermis [40]. Thrombosis of transverse and sigmoid sinus can also present with right-sided weakness and abnormal movements [42].…”

Section: Discussion Of the Case Reportsmentioning

confidence: 84%

“…The extent of right-sided weakness also varies with the area of cerebral hemispheres infarcted. Acute infarction of the brain territory supplied by the left middle cerebral artery can present as right hemiplegia, right hemiparesis with motor aphasia and dysarthria, or right brachiofacial hemiparesis, depending on the degree of gray or white matter involved [2,29,40]. Stenosis of the left internal carotid artery with acute ischemic changes in the territory of the left middle cerebral artery can also manifest as right-sided weakness with speech disorder and altered level of consciousness [43].…”

Section: Discussion Of the Case Reportsmentioning

confidence: 99%

“…Most physicians use long-term anticoagulation therapy for the prevention of thromboembolic events [44]. Based on the cases in Table 4, cerebral ischemia and infarction secondary to PC deficiency have been successfully managed by initial administration of heparin (mostly low molecular weight heparin) after hospital admission followed by long-term use of anticoagulant (warfarin in most of the cases) [26][27][28]31,36,[39][40][41][42].…”

Section: Managementmentioning

confidence: 99%

See 2 more Smart Citations

Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review

Majid

Tahir

Ahmed

et al. 2020

Cureus

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Section: Discussion Of the Case Reportsmentioning

confidence: 84%

Section: Discussion Of the Case Reportsmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review

Majid

Tahir

Ahmed

et al. 2020

Cureus

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“…Autoimmune disease also may induce a prothrombotic state promoting stroke, such as an HIV patient with protein C and protein S deficiency who developed a stroke in the presence of a PFO [15]. The prevalence rates of anti-cardiolipin antibodies in patients with ischemic strokes were 17-21% [16].…”

Section: Resultsmentioning

confidence: 99%

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Kar¹,

Aboulhosn²,

Tandar³

et al. 2017

jshd

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Background: Percutaneous closure devices for cardiac defects have been used with a high degree of efficacy and safety. However, patients with autoimmune disease or immunosuppression are excluded in clinical trials due to their presumed higher risk. Percutaneous closure of patent foramen ovale (PFO) or atrial septal defect (ASD) is safe in patients who are immunosuppressed or have autoimmune disease. Methods: A retrospective observational multicenter study was performed including 24 patients who were immunocompromised or had autoimmune disease from vasculitis, Human Immunodeficiency Virus, hepatitis, cancer, or renal transplant and underwent percutaneous PFO or ASD closure for cryptogenic stroke (9.38%), desaturation (5.21%), migraine (7.29%), or a combination of these diagnoses (3.13%). Post-procedure follow-up included clinical evaluation at 3-6 months or telephone questionnaire up to 8 years later. Results: Of the 24 patients who met inclusion criteria (53 ± 14 years of age, follow-up of 21 ± 28 months), 19 had a PFO (79%), 5 had an ASD (21%), and 21 (88%) underwent closure. There was no evidence of endocarditis, device erosion, exacerbation of migraine, or recurrent stroke. Only one patient (4%) experienced a transient neurologic deficit after closure due to complex migraine with visual aura. Mortality status, which was verified by the social security death index, showed five deaths related to non-cardiac conditions. Conclusion: This observational study of an uncommon condition suggests that percutaneous closure of a PFO or ASD is safe in immunocompromised patients.

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“…A retrospective case series of 40 patients showed that anti-phospholipid antibodies and hypercoagulability are common in patients with PFO who present with cryptogenic stroke [9]. A case-controlled study also showed that anti-phospholipid antibodies are strongly associated with PFO and atrial septal aneurysms [10]. Therefore, autoimmune diseases with various hypercoagulable factors may increase the risk of stroke.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Closure of Patent Foramen Ovale or Atrial Septal Defect in the Presence of Thrombophilia

Kar¹,

Noureddin²,

Aboulhosn³

et al. 2017

jshd

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Background: Some thrombophilic patients have been excluded from clinical trials of septal defect closure due to the presumed higher risk of thrombus formation. The purpose of this study was to assess whether pre-existing thrombophilia predisposes patients to adverse events after percutaneous patent foramen ovale (PFO) or atrial septal defect (ASD) closure. Methods: A retrospective observational study was performed including 147 patients with thrombophilia who were referred for percutaneous PFO or ASD closure for cryptogenic stroke or transient ischemic attack (n = 104, 70.7%), migraine (n = 30, 20.4%), peripheral embolism (n = 5, 3.4%), right ventricular enlargement (n = 2, 1.4%), desaturation (n = 1, 0.7%), or a combination of diagnoses (n = 4, 2.7%). Post-procedure follow-up included 3-6 month clinical evaluation, chart review, or phone call. Results: Of the 147 patients (46 ± 13 years of age, follow-up of 43.5 ± 34.7 months) who met the inclusion criteria, 142 had a PFO (96.6%), and 5 had an ASD (3.4%); 69 (46.9%) underwent closure. Of the closure patients, 1 (1.4%) developed thrombus (Amplatzer ASO device). There were no cases of endocarditis or device erosion. One patient had a stroke post-closure (1.4%). Of the 80 women with stroke, TIA, or peripheral arterial embolism, 52 (65.0%) were taking oral contraceptive pills or hormone replacement therapy at the time of the event.

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Cerebral Infarction in an HIV-Infected Patient with Combined Protein S and C Deficiency and a Patent Foramen Ovale

Cited by 3 publications

References 10 publications

Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review

Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review

Percutaneous Atrial Septal Closure in Immunocompromised Patients

Percutaneous Closure of Patent Foramen Ovale or Atrial Septal Defect in the Presence of Thrombophilia

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