Stroke, Vol 24, 19-25, Copyright © 1993 by American Heart Association
HR Martinez, RA Rangel-Guerra and LJ Marfil
BACKGROUND AND PURPOSE: Deficiencies in coagulant inhibitors protein C,
protein S, and antithrombin III increase the risk of venous thrombosis. We
describe 10 young adults with cerebral arterial thrombosis due to
deficiencies in these factors. METHODS: Sixty patients younger than 45
years were hospitalized because of acute ischemic stroke diagnosed through
computed tomography or magnetic resonance imaging. Cerebral angiography was
performed in 54 cases. Hematologic and coagulation profiles, autoantibody
screen, syphilis serology, and lupus anticoagulant were analyzed in all
patients. Among the total cases, Holter monitoring was performed in 13
patients, echocardiography in 20, and cerebrospinal fluid studies for
cysticercosis and tuberculosis in two. The quantitative analysis of protein
C, protein S (by Laurell rocket immunoelectrophoresis), and antithrombin
III (by radial immunodiffusion) was performed on admission and 3 months
after stroke in all patients and in relatives of six patients. RESULTS: In
10 cases (17%) the stroke was attributed to deficiency of coagulation
inhibitors: three men had protein C deficiency, two women had protein S
deficiency, and five had antithrombin III deficiency (three men and two
women). The cerebral infarction involved the carotid territory in these 10
patients. None had previous thromboembolic disease. Eight patients showed a
complete recovery. An acquired disorder was presumed in one protein
S-deficient and in two antithrombin III-deficient patients; the remainder
were considered heterozygous. CONCLUSIONS: The cerebral vasculature may be
primarily involved in the deficiency of these natural anticoagulants. Young
adults seem to be the most often affected. A knowledge of these new
clotting defects will enable the clinician to improve the prevention and
treatment of this devastating neurological disease.
ARTICLES
Ischemic stroke due to deficiency of coagulation inhibitors. Report of 10 young adults
Internal Medicine Department, Hospital Universitario U.A.N.L., Monterrey, Mexico.
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