In adults of any age the majority of strokes are ischaemic (caused by a blockage in the blood supply to the brain). diseases and uncommonly by disorders of hypercoagulation. Disorders of coagulation leading to thrombotic disorders are approximately 1% of all ischaemic strokes and 4-8% of strokes in young individuals. Similarly combined deficiency of proteins C and S can lead to hypercoagulable state and Brivanib rarely presents as a cerebrovascular accident. We describe here a case of a 25-year-old man who presented with right middle cerebral artery territory infarct due to protein C and S deficiency. Background Cerebrovascular diseases are one of the common causes of high morbidity and mortality all over the world and among all cerebrovascular diseases most Brivanib common being ischaemic stroke (85%).1-3 Stroke in young individuals poses a major problem as these young family members are the major bread earner of the family. Abraham et al4 from Vellore South India reported that 25% of cases of stroke occur in less than 40?years of age. Other Indian studies have highlighted a higher incidence (24-35%) of stroke in young populace.5 Atherothrombotic diseases are the most common cause of ischaemic stroke; however disorder of coagulation although uncommon can lead to hypercoagulability resulting in ischaemic stroke. Case presentation A 25-year-old man was admitted in King George Medical University or college Lucknow Uttar Pradesh India in 2012 with symptoms of weakness in the left half of the body slurring Brivanib of speech deviation of angle of mouth towards the right side SLC2A1 while talking along with difficulty in deglutition and drooling of saliva from your left side for 10?days. On inquiry no risk factors such as smoking obesity diabetes hypertension and valvular heart disease were found. Family history was unfavorable for other vascular events or any predisposing factors for stroke. On examination general examination was unremarkable and all peripheral pulses were normal. Nervous system examination showed normal higher mental function and speech was dysarthric. Cranial nerve examination showed left-sided upper motor neuron type of facial palsy along with absent gag reflex towards left side. Power was decreased in the left upper and lower limb (III/V). The rest of the systemic examinations were within normal limit. Investigations On routine investigation haemoglobin was 13?gm/dL total leucocyte count 12?000/dL platelet count 1.52?lac/mm3 with haematocrit of 39% erythrocyte sedimentation rate 28?mm prothrombin time 13?s (control 12?s) International Normalised Ratio 1.1 and activated partial thromboplastin time 22?s (control 20?s). Urine analysis chest X-ray and fundus examination were unremarkable. Kidney and liver function tests were within normal range. Ultrasonography of the stomach and continuous wave Doppler sonography study of the carotid vertebral arteries and all four limbs were normal. Transthoracic and transoesophageal echocardiography did not reveal any abnormalities. Protein C level was 38?models/mL (normal 67-195?models/mL) protein Brivanib S level was 20?models/mL (normal 55-123?models/mL) and antithrombin III (AT III) level was 88?models/mL (normal 70-122?models/mL). Serum homocysteine level lipid profile antinuclear factor and antiphospholipid antibodies were within normal limits. Factor V Leiden mutation was not detected. CT of the brain was performed which showed a Brivanib large wedge-shaped hypodense area suggestive of infarct in the right frontotemporoparietal region (figures?1 and ?and22). Physique?1 CT scan showing infarct in the middle cerebral artery territory region. Physique?2 Brain CT showing infarct in the right frontotemporal region. Differential diagnosis Cardioembolism Arterial dissection Vasculitis/antiphospholipid antibody syndrome Thrombophilia Premature atherosclerosis Treatment After initial therapy with heparin the patient was kept on warfarin for Brivanib long-term treatment (anticoagulation) which was started at a low dose and was gradually increased. End result and follow-up The patient was discharged from the hospital in good condition after 2?weeks.
Katika watu wazima wa umri wowote, uvimbe mwingi ni wa ischemic (unaosababishwa na kizuizi cha damu katika ubongo). Ugonjwa wa kawaida wa kawaida ni ugonjwa wa hypercoagulation. Matatizo ya coagulation ambayo husababisha matatizo ya thrombotic ni karibu 1% ya kiharusi ischemic na 4-8% ya kiharusi katika vijana. Vivyo hivyo, upungufu wa protini C na S unaweza kusababisha hali ya hypercoagulable na Brivanib mara chache huonyesha kama ajali ya cerebrovascular. Katika kesi hii, mtu mwenye umri wa miaka 25 alipata ugonjwa wa moyo wa mkojo wa mkojo wa katikati wa ubongo kwa sababu ya upungufu wa protini C na S. Ugonjwa wa Cerebrovascular ni moja ya sababu za kawaida za ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa. "Abraham et al. kutoka Vellore, India Kusini, waliripoti kwamba ""25% ya visa vya kiharusi hutokea kwa chini ya miaka 40.""" Utafiti mwingine wa India umeonyesha kuwa watu vijana wana ugonjwa wa kiharusi mara nyingi zaidi, na ugonjwa wa atherothrombotic ndio sababu ya kiharusi cha ischemic, lakini ugonjwa wa coagulation unaweza kusababisha hypercoagulability na kusababisha ischemic stroke. Mwanamume mwenye umri wa miaka 25 alilazwa katika Chuo Kikuu cha Matibabu cha King George, Lucknow, Uttar Pradesh, India mnamo 2012 na dalili za udhaifu katika nusu ya kushoto ya mwili, kusonga, kutoelewana kwa usemi, kupotoka kwa pembe ya mdomo kuelekea upande wa kulia, na shida ya kumeza na kutokwa na mate kutoka upande wako wa kushoto kwa siku 10. Katika uchunguzi hakuna sababu za hatari kama vile kuvuta sigara, unene wa kupita kiasi, kisukari, shinikizo la damu la juu na ugonjwa wa moyo wa valve. Historia ya familia haikuwa nzuri kwa matukio mengine ya mishipa ya damu au sababu zozote za kuambukiza kiharusi. Katika uchunguzi uchunguzi wa jumla haukuwa wa kushangaza na msukumo wote wa pembeni ulikuwa wa kawaida. Uchunguzi wa mfumo wa neva ulionyesha utendaji wa akili wa juu wa kawaida na usemi ulikuwa dysarthric. Uchunguzi wa neva ya fuvu la kichwa ulionyesha aina ya neuron ya juu ya injini ya upande wa kushoto ya kupooza kwa uso pamoja na kutokuwepo kwa mwelekeo wa kugonga kuelekea upande wa kushoto. Nguvu ilipungua katika mguu wa juu na wa chini wa kushoto (III / V). Uchunguzi mwingine wa mfumo ulikuwa ndani ya mipaka ya kawaida. Katika uchunguzi wa kawaida, hemoglobini ilikuwa 13 gm2dL, jumla ya leukocyte ilikuwa 12,000 dL, idadi ya platelets ilikuwa 1.52 ml, na hematocrit ilikuwa 39% na kiwango cha sedimentation cha erythrocyte ilikuwa 1.28 ml, muda wa prothrombin ulikuwa 13 s (udhibiti 12 s), uwiano wa kimataifa wa kawaida na muda wa thromboplastin ulianzishwa ulikuwa 22 s (udhibiti 20 s). Uchunguzi wa mkojo, uchunguzi wa X-ray ya kifua, na uchunguzi wa fundus haukuwa na matokeo mazuri. Uchunguzi wa utendaji wa figo na ini ulikuwa ndani ya kiwango cha kawaida. Ultrasound ya tumbo na uchunguzi wa sonografia ya Doppler ya mawimbi ya kuendelea ya mishipa ya mshipa wa damu na viungo vyote vinne vilikuwa vya kawaida. Uchunguzi wa transsthoracic na transoesophageal echocardiography haukufunua kasoro zozote. Kiwango cha protini ya Brivivab ilikuwa 38 mL (kiwango cha kawaida cha 67 mL) na kiwango cha antithrombin III (kiwango cha kawaida cha 70 mL) kilikuwa 88 mL (kiwango cha kawaida cha 70 mL). Kiwango cha homocysteine seramu lipid profile antinuclear sababu na antiphospholipid kingamwili walikuwa ndani ya mipaka ya kawaida. Mabadiliko ya Factor V Leiden hayakugunduliwa. CT ya ubongo ilionyesha eneo kubwa la brivini, ambalo linaonekana kuwa na infarct katika eneo la mbele la mbele (picha ya 1 na 2). CT scan ya 1 inaonyesha infarct katika eneo la eneo la mshipa wa kati wa ubongo. Ugonjwa wa utumbo wa ubongo (C2C) unaonyesha infarct katika eneo la mbele la kichwa. Ugonjwa wa Cardiomyelitis, Vascularitis, Antifosfolipid Antibody Syndrome, Thrombophilia, na Atherosclerosis ya mapema: Baada ya matibabu ya awali na heparin, mgonjwa aliendelea na warfarin kwa matibabu ya muda mrefu ya Brivinip, ambayo ilianza kwa kipimo cha chini na kuongezeka hatua kwa hatua. Matokeo ya mwisho na ufuatiliaji Mgonjwa aliachiliwa kutoka hospitali katika hali nzuri baada ya wiki mbili.