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A case of ischemic stroke associated with protein-losing gastroenteropathy and protein S deficiency

Kazuki Kimoto1, Tomohisa Nezu2, Eiichi Nomura1

  • 1Department of Neurology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|April 28, 2023
PubMed

Protein-losing gastroenteropathies are characterized by an excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoalbuminemia. Some rare cases are complicated with ischemic stroke. We report a 24-year-old woman who developed acute dysarthria and right hemiplegia 4 months after delivering her first baby by cesarean section. Diffusion-weighted magnetic resonance imaging showed a high-intensity signal in the left anterior cerebral artery territory and middle cerebral artery territory. She had marked hypoalbuminemia and decreased protein S activity. We identified protein-losing gastroenteropathy as the cause of the hypoalbuminemia, and she had a missense mutation of the PROS 1 gene, which was associated with decreased protein S activity. We speculated that the development of protein-losing gastroenteropathy accelerated the decline in protein S activity and caused cerebral infarction.

Keywords:
HypoalbuminemiaIschemic strokeProtein S deficiencyProtein-losing gastroenteropathy

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