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

J Stroke Cerebrovasc Dis. 2023 Jul;32(7):107151. doi: 10.1016/j.jstrokecerebrovasdis.2023.107151. Epub 2023 Apr 26.

Abstract

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: Hypoalbuminemia; Ischemic stroke; Protein S deficiency; Protein-losing gastroenteropathy.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cesarean Section / adverse effects
  • Female
  • Humans
  • Hypoalbuminemia* / complications
  • Hypoalbuminemia* / diagnosis
  • Ischemic Stroke* / complications
  • Pregnancy
  • Protein S
  • Protein S Deficiency* / complications
  • Protein S Deficiency* / diagnosis
  • Stroke* / complications
  • Stroke* / diagnostic imaging
  • Young Adult

Substances

  • Protein S