Homozygous prothrombin gene mutation and ischemic cerebrovascular disease

We report the case of a 31-year-old woman who, at the age of 26 suffered fr om an episode of superficial thrombophlebitis in the left leg, experienced two episodes of transient ischemic attacks at the age of 30 and had an isch emic stroke with left-sided hemiparesis at the age of 31 years. A cerebral CT scan showed an ischemic lesion in the right sylvian area involving the o percular and nucleocapsular regions. Her father had had an ischemic stroke at the age of 54 years and died at the age of 58; her mother had had a myoc ardial infarction at the age of 48 years and died at 51 years from breast c ancer. Laboratory investigation of the patient demonstrated high levels of fibrinogen, F II, F VII, F 1 + 2, FPA and ACA-IgG with low levels of HDL ch olesterol associated with homozygosity for the 20210 A genotype. There were no other genetic or acquired prothrombotic defects. In conclusion, this ca se strongly suggests a clinically significant role of the prothrombin gene mutation in both arterial and venous thrombosis.