Cerebral Infarction Associated with Free Protein S Deficiency

J Korean Neurol Assoc > Volume 18(1); 2000 > Article

Journal of the Korean Neurological Association 2000;18(1): 8-11.

Free Protein S 결핍과 연관된 뇌경색

김요식, 박현영 ·조광호

원광대학교 의과대학 신경과학교실

Cerebral Infarction Associated with Free Protein S Deficiency

Yo Sik Kim, M.D., Hyun Young Park, M.D., Kwang Ho Cho, M.D.

Department of Neurology, Wonkwang University, School of Medicine

Abstract

Background : Coagulation abnormalities account for 1% to 5% of the causes of adult stroke. The importance of pro-thrombotic condition as a cause of stroke has been the subject of intense controversy. The role of protein S deficiency in the etiology of stroke and the clinical pattern of cerebral infarction caused by the prothrombotic state are still unclear. We investigated clinical characteristics of cerebral infarction caused by free protein S (FPS) deficiency. Methods : We enrolled patients with cerebral infarction over 2 years. Cerebral infarction was classified into transient ischemic attack, lacunar infarction, embolic infarction, and thrombotic infarction. We assayed free protein S, prothrom-bin time (PT), and activated partial thromboplastin time (APTT) within 24 hours after stroke and measured free protein S and protein S Ag at 3 months after cerebral infarction. All patients underwent a cardiological examination and neu-roimaging study, and cerebral angiography was done only when necessary. Results : Eight patients (1.67%) among 474 patients with cerebral infarction had FPS deficiency as a cause of stroke. Four were male and four were female. The history of venous thrombosis was not noted. The age of patients were from 24 to 83 years old at the time of stroke. Two patients had family members with FPS deficiency. The types of stroke were variable, such as thrombotic infarction in 3 patients, lacunar infarction in 4 patients, and embolic infarction in one patient. Cerebral arterial stenosis was noted in 3 patients. Other associated risk factors of stroke were smoking, hypertension, pregnancy, low HDL cholesterol, sinus bradycardia, left ventricular hypertrophy on EKG, and old age. All patients had normal PT, APTT, and liver function test. Conclusions : FPS deficiency can be a risk factor for cerebral infarction in young patients as well as old patients. Free protein S (FPS) deficiency may increase risk of cerebral infarction in the presence of other risk factors of stroke but this requires confirmation by a large study in unselected patients. J Korean Neurol Assoc 18(1):8~11, 2000 Key Words : Cerebral infarction, Protein S, Free protein S deficiency