PT  - JOURNAL ARTICLE
AU  - Manali Chandra
AU  - Atanu Chandra
AU  - Sayantan Chakraborty
AU  - Joydeep Ghosh
TI  - Midbrain infarction in inherited protein S deficiency: a rare association
AID  - 10.1136/bcr-2021-246073
DP  - 2021 Oct 01
TA  - BMJ Case Reports
PG  - e246073
VI  - 14
IP  - 10
4099  - http://casereports.bmj.com/content/14/10/e246073.short
4100  - http://casereports.bmj.com/content/14/10/e246073.full
SO  - BMJ Case Reports2021 Oct 01; 14
AB  - 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.