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Is hormone replacement a risk factor for ischemic stroke in women with factor V Leiden mutation?
J F Meschia1, J Biller, T Witt
1Department of Neurology, Mayo Clinic Jacksonville, Fla 32224, USA. meschia.james@mayo.edu
Objective:
To describe a patient with multifocal cerebral ischemia whose only identified potential risk factors were use of postmenopausal hormone replacement and heterozygosity to factor V Leiden mutation.
Design:
A case report.
Setting:
A tertiary care center.
Patient:
A 51-year-old woman taking hormone replacement (0.625 mg/d of estrogen alternating with 10 mg/d of medroxyprogesterone) presented with a generalized tonic-clonic seizure. She had persistent multifocal non-enhancing lesions on magnetic resonance imaging of the brain. A stereotactic biopsy of the brain performed to exclude gliomatosis cerebri was consistent with cerebral ischemia. An extensive evaluation to uncover the cause of stroke revealed only heterozygosity to factor V Leiden mutation.
Main Outcome And Results:
Hormonal replacement was discontinued and the patient had no recurrent ischemic strokes.
Conclusions:
Postmenopausal hormonal replacement may be a risk factor for ischemic stroke in women with the factor V Leiden mutation. Ongoing trials of hormonal replacement provide an opportunity to test this hypothesis.