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 who se only identified potential risk factors were use of postmenopausal h ormone replacement and heterozygosity to factor V Leiden mutation. Des ign: A case report. Setting: A tertiary care center. Patient: A 51-yea r-old woman taking hormone replacement (0.625 mg/d of estrogen alterna ting with 10 mg/d of medroxyprogesterone) presented with a generalized tonic-clonic seizure. She had persistent multifocal nonenhancing lesi ons on magnetic resonance imaging of the brain. A stereotactic biopsy of the brain performed to exclude gliomatosis cerebri was consistent w ith cerebral ischemia. An extensive evaluation to uncover the cause of stroke revealed only heterozygosity to factor V Leiden mutation. Main Outcome and Results: Hormonal replacement was discontinued and the pa tient had no recurrent ischemic strokes. Conclusions: Postmenopausal h ormonal replacement may be a risk factor for ischemic stroke in women with the factor V Leiden mutation. Ongoing trials of hormonal replacem ent provide an opportunity to test this hypothesis.