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We examined the relationship between free protein S deficiency and cerebrovascular disease by reviewing the records of all patients with the diagnoses of cerebral thrombosis,cerebral embolism,and cerebral vascular occlusion who were referred for coagulation studies over a 12-month period.We assayed for free protein S antigen,protein C antigen,and antithrombin III and tested for lupus-like anticoagulant and anticardiolipin antibody.Twenty-two of 267 patients(8.2%)admitted with thrombotic strokes were referred for coagulation studies.Free protein S antigen was significantly lower in women than in men(62+/-25%versus 88+/- 24%,p=0.03;n=11 in each group).Six women had free protein S antigen levels below the range recorded for a contemporary group of 24 age-matched normal women(17 to 59%versus 70 to 102%,p<0.001);four of these women had cerebral arterial thrombosis and two had venous dural sinus thrombosis.The six women were aged 29 to 55 at the time of their first strokes;two had family members with protein S deficiency,and one of these had died of a stroke at age 52.Other abnormalities in this population included a positive test for lupus-like anticoagulant or anticardiolipin in five patients,a modest decrease in protein S in two men,and one patient with an isolated deficiency of antithrombin III.We conclude that protein S deficiency may be an important risk factor for stroke in middle-aged women but this requires confirmation by prospective studies in unselected patients. |
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cerebral venous thrombosis
cerebral venous thrombosis,etiology
cerebrovascular accident
cerebrovascular accident,familial occurrence
cerebrovascular accident,women
cerebrovascular disease,risk factors in
familial
protein S deficiency
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