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(Stroke. 1996;27:1731-1733.)
© 1996 American Heart Association, Inc.

Articles

Cerebral Venous Thrombosis and Activated Protein C Resistance

Douglas A. Dulli, MD; Christopher C. Luzzio, MD; Eliot C. Williams, MD, PhD Henry S. Schutta, MD

the Departments of Neurology (D.A.D., C.C.L., H.S.S.) and Medicine (E.C.W.), University of Wisconsin-Madison Medical School.

Correspondence to Henry S. Schutta, Department of Neurology, University of Wisconsin Medical School, 600 Highland Ave, Madison, WI 53792. E-mail schutta@neurology.wisc.edu.

Background Activated protein C resistance (APC-R) due to factor V Leiden has recently been established as an important risk factor for cerebral venous thrombosis (CVT). The clinical significance of abnormal or borderline functional APC-R in the absence of factor V Leiden is uncertain. Our observations suggest that APC-R due to mechanisms other than factor V Leiden may also contribute to the development of CVT.

Case Descriptions We describe three women who had superior sagittal and lateral sinus thrombosis while taking oral contraceptives and had a number of additional risk factors for CVT. Each had APC-R for different reasons.

Conclusions Inherited thrombophilia, including APC-R, should be looked for in all patients with CVT. Functional APC-R is a highly prevalent coagulopathy, but the reasons for this abnormality are diverse; abnormal and borderline functional APC-R results should be supplemented by DNA analysis for the presence of factor V Leiden.

Key Words: cerebral embolism and thrombosis • contraceptives, oral • protein C • protein S deficiency • sinus thrombosis

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