An Embolic Stroke in a Patient With PROC p.Lys193del

Kana Ueki, Kuniyuki Nakamura, Yoshinobu Wakisaka, Shinichi Wada, Yoji Yoshikawa, Shinya Matsumoto, Taeko Hotta, Dongchong Kang, Takanari Kitazono, Tetsuro Ago

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We report a 58-year-old woman who suddenly developed brain infarction with weakness of the left lower extremity and left perioral dysesthesia during postoperative tamoxifen therapy for breast cancer and prednisolone therapy for rheumatoid arthritis. Diffusion-weighted images detected multiple areas of hyperintensity in the posterior circulation system of the brain. Despite extensive examinations, we could not identify any embolic sources except hypoplasia of the right vertebral artery. We found decreased activity of protein C against its antigen level (activity: 59% versus antigen: 122%) with enhanced activity of coagulation factor VIII (178%) and von Willebrand factor (285%). DNA sequencing identified trinucleotide deletion of the PROC gene leading to 1 amino acid deletion at Lys-193 (p.Lys193del). We speculate that the PROC gene polymorphism may have participated in tamoxifen- and prednisolone- associated hypercoagulable state, leading to development of an embolic stroke in this patient.

Original languageEnglish
Article number104597
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number5
Publication statusPublished - May 2020

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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