Is hormone replacement a risk factor for ischemic stroke in women with factor V Leiden mutation?
OBJECTIVE
To describe a patient with multifocal cerebral ischemia whose only identified potential risk factors were use of postmenopausal hormone replacement and heterozygosity to factor V Leiden mutation.


METHODS
A case report.


METHODS
A tertiary care center.


METHODS
A 51-year-old woman taking hormone replacement (0.625 mg/d of estrogen alternating with 10 mg/d of medroxyprogesterone) presented with a generalized tonic-clonic seizure. She had persistent multifocal non-enhancing lesions on magnetic resonance imaging of the brain. A stereotactic biopsy of the brain performed to exclude gliomatosis cerebri was consistent with cerebral ischemia. An extensive evaluation to uncover the cause of stroke revealed only heterozygosity to factor V Leiden mutation.


RESULTS
Hormonal replacement was discontinued and the patient had no recurrent ischemic strokes.


CONCLUSIONS
Postmenopausal hormonal replacement may be a risk factor for ischemic stroke in women with the factor V Leiden mutation. Ongoing trials of hormonal replacement provide an opportunity to test this hypothesis.
Department of Neurology, Mayo Clinic Jacksonville, Fla 32224, USA. meschia.james@mayo.edu
J F
JF
Meschia
J
J
Biller
T
T
Witt
A
A
Greist
S N
SN
Rhinehart
D002545:Brain Ischemia / Q000139:chemically induced / Q000150:complications* / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005165:Factor V; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009154:Mutation; D012307:Risk Factors
C095381:factor V Leiden; D005165:Factor V