Gutiérrez MJL, Domínguez MR, Morales EM, Rossiere ENL

Language: Spanish
References: 27
Page: 19-22
PDF size: 188.60 Kb.

ABSTRACT

Introduction: Ischemic vascular disease in young patients is defined as the one that occurs in people under 45 years of age. The study protocol of young patients with this problem should include a search for etiologies different from the frequent or traditional ones, for example, Protein S deficiency which causes 5% of thrombotic episodes in young patients. We present a case of stroke in a young patient due to protein S deficiency associated with primary hypothyroidis, and Déjerine- Roussy syndrome secondarily acquired.
Case Presentation: A 45 year-old female was admitted to the ER presenting monoparesis of the left pelvic limb. On physical examination she was stuporous with left hemiparesis and dysesthesias on the same side. Vital signs were normal. On laboratory studies protein S deficiency and primary hypothyroidism were found. The CT showed infarction with hemorrhagic transformation in the right thalamus.
Discussion: The ischemic lesion probably became hemorrhagic as a result of the primary hypothyroidism that may have caused a decdecrease of Von Willebrand and Factor VIII coagulation factors.

REFERENCES

1. Olmos Olmos AA, Nuñez Orozco L. Enfermedad vascular cerebral isquémica en menores de 45 años. Rev Mex Neuroci. 2000;1:5-11.

2. Kappelle LJ, Adams HP, Heffner ML, et al. Prognosis of young adults. Stroke. 1994;25:1360-5.

3. Chein We, Huey JL, Yi SH. Evident risk factors for younger stroke patients in Taiwan. J Stroke Cerebrovasc Dis. 1995; 5:158-16.

4. Chimowitz MI. Ischemic stroke in the young. In: primer on cerebrovascular diseases. Academic Press. 1997:330-2.

5. Burneo de las Casas J. Ataques cerebrovasculares isquémicos en pacientes jóvenes. Reporte de casos y revisión de la literatura. Rev Med Hered. 1999;10:167-74.

6. Lobato-Mendizabal E, Ruíz-Argüelles GJ. Proteína C, proteína S y trombomodulina. Uno de los mecanismo antitrombóticos naturales. Rev Invest Clin. 1990;42:54-62.

7. Barinagarrementeria F, Gonzáles-Duarte A, Cantú-Brito C. Estados protombóticos e isquemia cerebral. Rev Neurol. 1998;26:85-91.

8. Clouse LH, Comp PC. The regulation of hemostasis: the protein C system. N Engl J Med. 1986;314:1298-300.

9. Dahlback B. Protein S and c4b-binding protein: components involved in the regulation of the protein c anticoagulant system. Thromb Haemost. 1991;66:49-61.

10. Esmon CT. The roles of protein C and thrombomodulin in the regulation of blond coagulation. J Biol Chem. 1989; 264:4743-6.

11. Nezih O, Tayfun D. Protein S deficiency, epileptic seizures, sagittal sinus thrombosis and hemorrhagic infarction after ingestion of dimenhydrinate. Turkish Neurosurgery. 2008;18:85-8.

12. García-Plaza J, Jiménez AC. Aspectos clínicos de los déficits de proteína C y proteína S. Sangre. 1985;30:797-801.

13. Tatlisumak T, Fisher M. Hematologic disorders associated with ischemic stroke. J Neurol Sci. 1996;140:1-11.

14. Vieregge P, Schwieder G, Kompf O. Cerebral venous thrombosis in hereditary protein C deficiency. J Neurol Neurosurg Psychiatry. 1989;52:135-7.

15. Comp PC. Hereditary disorders predisposing to thrombosis. Prog Hemost Thromb. 1986;8:71-98.

16. Schafer HP, von Felten A. Protein S deficiency in young patients with thrombotic brain infarction. Schweiz Med Wochenschr. 1989;16:489-92.

17. Barinagarrementeria F, Figueroa T, Huebe J, et al. Cerebral infarction in people under 40 years. Cerebrovasc Dis. 1996;6:75-9.

18. Green D, Otoya J, Oriba H, et al. Protein S deficiency in middleaged women with stroke. Neurology. 1992;42:1029-33.

19. Luboshitzky R, Aviv A, Herer P, et al. Risk factors for cardiovascular disease in women with subclinical hypothyroidism. Thyroid. 2002;12:421-5.

20. Christ-Crain M, Meier C, Guglielmetti M, et al. Elevated Creactive protein and homocysteine values: cardiovascular risk factors in hypothyroidism? A cross-sectional and double-blind, placebo-controlled trial. Atherosclerosis. 2003;166:379-86.

21. Homoncik M, Gessl A, Ferlitsch A, et al. Altered platelet plug formation in hyperthyroidism and hypothyroidism. J Clin Endocrinol Metab. 2007;92:3006-12.

22. Salazar-Zúñiga A, Carrasco-Vargas H. Tratamiento del síndrome talámico (Dejerine-Roussy) secundario a infarto cerebral isquémico con gabapentina. Reporte de cuatro casos y revisión de la literatura. Neurol Neurocir Psiquiat. 2006;39:70-5.

23. Weitz JI. Antithrombin III, protein C and protein S deficiency. En: Carbone P. Current therapy in Hematology – Oncology. Missouri: Mosby Year book; 1995. p. 201-9.