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The factor V Leiden mutation is a specific point mutation in the gene coding for factor
V. It renders activated factor V resistant to degradation by activated protein C (APC).
This hereditary resistance to APC (HRAPC) is a known risk factor for systemic venous
thrombosis. We present a case of homozygous HRAPC presenting as cerebral venous thrombosis
(CVT). A 24-year-old woman presented with a dense left hemiplegia and papiledema.
A computed tomography scan showed a high ritht parieto-occipital infarct with hemorrhagic
conversion. Angiography confirmed the diagnosis of extensive CVT. Treatment included
heparin and direct intrathrombus thrombolysis initially as a bolus and then as an
infusion for 21 hours. Repeat angiography showed partial recanalization. After 9 days,
the patient was discharged on warfarin with minimal residual left weakness but persistent
papilledema. Homozygous HRAPC appears to be a risk factor for CVT and should be considered
in the evaluation of CVT
Key words
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Article info
Publication history
Accepted:
December 17,
1996
Received:
July 8,
1996
Identification
Copyright
© 1997 National Stroke Division. Published by Elsevier Inc.
