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J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e650-2. doi: 10.1016/j.jstrokecerebrovasdis.2013.04.019. Epub 2013 May 10.

Cerebral infarction in an HIV-infected patient with combined protein S and C deficiency and a patent foramen ovale.

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Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.


A 41-year-old male with a history of human immunodeficiency virus (HIV) infection developed motor aphasia, dysarthria, and right hemiparesis. A magnetic resonance imaging scan of the brain revealed a cerebral infarction in the territory of the left middle cerebral artery. The laboratory data showed decreased levels of protein S and protein C. Transesophageal contrast-enhanced echocardiography revealed a patent foramen ovale (PFO). Prothrombotic states, such as protein S and C deficiency, have been reported in HIV-infected patients. In addition, previous studies have reported prothrombotic states to be risk factors for PFO-related cerebral infarction. An association between combined protein S and C deficiency caused by HIV infection and PFO-related cerebral infarction was suggested in our patient.


Cerebral infarction; human immunodeficiency virus; patent foramen ovale; protein C deficiency; protein S deficiency

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