Ischemic Stroke in Young due to Combined Protein C and S Deficiency

Abstract

Abstract:WHO defines stroke as an event caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue [1]. Globally, stroke is the third commonest cause of mortality [2] and the fourth leading cause of disease burden [3]. Ischemic stroke is the most common cerebrovascular disease, most often due to atherothrombotic diseases and uncommonly by disorders of hypercoagulation. Disorders of coagulation leading to thrombotic disorders are approximately 1% of all ischemic strokes and 4-8% of young strokes. Similarly combined deficiency of protein C and S can lead to hypercoagulable state and rarely present as cerebrovascular accident. We describe here a rare case of 27 year old male who presented with right middle cerebral artery territory infarct due to combined protein C and S deficiency.Key words: Stroke, Blood Coagulation, Protein C, Infarction, Middle Cerebral Artery, Brain. IntroductionCerebrovascular diseases are one of the common causes of high morbidity and mortality all over the world and out of all cerebrovascular diseases most of them are ischemic strokes (85%). Stroke in young individual poses a major problem as these young family members are the major income earner of the family. Abraham et al [4] from Vellore, South India reported that 25% cases of the stroke were less than 40 years of age. Other Indian studies have highlighted a high incidence 24-35% of stroke in young population [5]. Atherothrombotic diseases are most common cause for ischemic stroke, however disorder of coagulation although uncommon but can lead to hypercoagulability resulting in ischemic stroke. Case ReportA 27 year old male presented with complains of weakness in left side of body since last 10 days. General physical examination was unremarkable. Neurological examination revealed findings consistent with left-sided hemiparesis. No precipitating factors such as obesity, diabetes, hypertension, valvular heart disease, chronic drug intake, intravenous drug abuse and smoking were present. Family history was negative for vascular events

Arthroscopic release using F and C method versus conventional open release method in the treatment of gluteal muscle contracture: a comparative study

“…GMC exists all across the globe but is more prevalent in China, with childhood incidence rate of 1–2.5% [4–8]. It is associated with intramuscular injections of antibiotics and antimalarial agents like quinine into buttocks [9–12].…”

Ischemic stroke due to protein C deficiency

“…Protein S deficiency has been associated with cerebral arterial ischemia more often than protein C deficiency. 1 In our patient, ischemic stroke with clinical symptoms of hemiplegia, motor dysphasia followed by deteroriation of consciousness was established by CT Scan and MRI Brain. Embolic infarction from a cardiac source or arterio-arterial embolism due to preexisting carotid artery sclerosis could largely be excluded as could immunological diseases.…”

“…As cardioembolism, large artery disease with arteriolosclerosis and thromboembolism, and small artery disease. 1 In some cases, causes remain unclear. [2][3][4] Protein C deficiency is a rare cause of ischemic stroke.…”

Endomyocardial Fibrosis and the Prothrombotic State: From Hypercoagualability to Protien C Deficiency

“…Classically Protein C deficiency due to congenital reasons has been associated with deep venous thrombosis [19]. But newer reports link Protein C deficiency to intra-arterial thrombosis, blindness, stroke or even purpurafulminans [20][21][22][23]. However, an interesting recent report has reported gross intra-cavitary thrombosis with protein C deficiency.…”