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VOLUME 10 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Ischemic Stroke Following Spontaneous Intracerebral Hemorrhage in a Patient with Protein S Deficiency: A Case Report

Anandi Damodaran, Leena Awad Ahmed, Rehab Abdoqasem, Devdutt Nayak Kotekar

Keywords : Case report, Intracerebral hemorrhage, Ischemic stroke, Ischemic stroke following intracerebral hemorrhage, Protein S deficiency

Citation Information : Damodaran A, Ahmed LA, Abdoqasem R, Kotekar DN. Ischemic Stroke Following Spontaneous Intracerebral Hemorrhage in a Patient with Protein S Deficiency: A Case Report. Bengal Physician Journal 2023; 10 (3):105-106.

DOI: 10.5005/jp-journals-10070-8027

License: CC BY-NC 4.0

Published Online: 21-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Intracerebral hemorrhage (ICH) accounts for 20% of all strokes and is a significant cause of mortality and disability. Intracerebral hemorrhage survivors are at high risk of recurrence of ICH with a risk of 1.3–7.4%. While we are more concerned with the recurrence of ICH, ischemic infarcts are also frequent. This raises the therapeutic dilemma about the benefit of starting antithrombotic agents without increasing the risk of ICH. Here we report a patient who presented to our hospital with hypertensive parenchymal bleed and later developed cerebellar infarct within 1 week of admission. Our patient is a 40-year-old male without any comorbidities presented with accelerated hypertension and right hemiparesis. Computed tomography (CT) was done immediately showed intracerebral bleed with intraventricular bleed. Repeat CT brain one week later showed subacute infarct in cerebellar region. On further work he was found to have protein S deficiency. Intracerebral hemorrhage survivors have an increased risk of recurrent hemorrhage and ischemic stroke. Data on the burden of ischemic events and their predictors following an ICH is still lacking. Various studies observed that prior ischemic stroke, aggressive blood pressure lowering, and surgical evacuation of ICH were independently associated with diffusion-weighted lesions. It is also postulated that aggressive lowering of blood pressure in chronic hypertensive ICH patients can compromise cerebral perfusion pressure which contributes to ischemic injury. According to the limited studies so far, primary ICH patients are at risk of another major vascular event including ischemic stroke. This poses a therapeutic dilemma about blood pressure lowering and also the time frame to start antithrombotic. Further studies may be needed to determine and analyze the risk factors for developing ischemic injuries and the impact of these infarcts on the outcome and optimal management strategies to arrest vascular damage.

  1. Casolla B, Moulin S, Kyheng M, et al. Five-year risk of major ischemic and hemorrhagic events after intracerebral hemorrhage. Stroke 2019;50(5):1100–1107. DOI: 10.1161/STROKEAHA.118.024449.
  2. Hill MD, Silver FL, Austin PC, et al. Rate of stroke recurrence in patients with primary intracerebral hemorrhage. Stroke 2000;31(1):123–127. DOI: 10.1161/01.str.31.1.123.
  3. Menon RS, Burgess RE, Wing JJ, et al. Predictors of highly prevalent brain ischemia in intracerebral hemorrhage. Ann Neurol 2012;71(2):199–205. DOI: 10.1002/ana.22668.
  4. Prabhakaran S, Gupta R, Ouyang B, et al. Acute brain infarcts after spontaneous intracerebral hemorrhage: A diffusion-weighted imaging study. Stroke 2010;41(1):89–94. DOI: 10.1161/STROKEAHA.109.566257.
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