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In adults of any age, the majority of strokes are ischaemic (caused by a blockage in the blood supply to the brain). Stroke in young individuals poses a major health problem. The WHO defines stroke as an event caused by the interruption of the blood supply to the brain, usually because of rupture of a blood vessel or blockage by a clot. This hampers the supply of oxygen and nutrients, causing damage to the brain tissue. Globally, stroke is the third commonest cause of mortality and the fourth leading cause of disease burden. Ischaemic stroke is the most common cerebrovascular disease, most often due to atherothrombotic 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 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.

Combined deficiency of proteins C and S: ischaemic stroke in young individuals