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Midbrain infarction in inherited protein S deficiency: a rare association
  1. Manali Chandra1,
  2. Atanu Chandra2,
  3. Sayantan Chakraborty1 and
  4. Joydeep Ghosh1
  1. 1Internal Medicine, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
  2. 2Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
  1. Correspondence to Dr Atanu Chandra; chandraatanu123{at}


Inherited thrombophilic disorders are well‐established predisposing factors for venous thromboembolism, but their role in arterial ischaemic stroke is uncertain. The exact mechanism of arterial thrombosis in thrombophilias remains elusive. Herein, we report a case of a 30-year-old woman who was admitted to our facility with sudden-onset right-sided ptosis and ophthalmoplegia. Detailed clinical features, neuroimaging and laboratory evaluation clinched the diagnosis of ischaemic stroke in midbrain due to microvascular obstruction associated with isolated protein S deficiency. She was treated with oral anticoagulant (warfarin) and physiotherapy; without any improvement of her symptoms at 2 months of follow-up. A high index of clinical suspicion is needed in any case of young ischaemic stroke in absence of common cardiac and vascular risk factors, to recognise the presence of inherited thrombophilia.

  • neurology
  • brain stem / cerebellum
  • stroke
  • general practice / family medicine

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  • Contributors MC and AC contributed to conception, initial drafting of manuscript, critical revision of content and final approval of manuscript. MC, SC and JG contributed to patient management. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.