{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:10:04Z","timestamp":1756285804824,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,10,2]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>Inherited thrombophilic disorders are well\u2010established predisposing factors for venous thromboembolism, but their role in arterial ischaemic stroke is uncertain. The exact mechanism of arterial thrombosis in thrombophilias remains elusive. Herein, we report a case of a 30-year-old woman who was admitted to our facility with sudden-onset right-sided ptosis and ophthalmoplegia. Detailed clinical features, neuroimaging and laboratory evaluation clinched the diagnosis of ischaemic stroke in midbrain due to microvascular obstruction associated with isolated protein S deficiency. She was treated with oral anticoagulant (warfarin) and physiotherapy; without any improvement of her symptoms at 2\u2009months of follow-up. A high index of clinical suspicion is needed in any case of young ischaemic stroke in absence of common cardiac and vascular risk factors, to recognise the presence of inherited thrombophilia.<\/jats:p>","DOI":"10.1136\/bcr-2021-246073","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T14:00:39Z","timestamp":1634652039000},"page":"e246073","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Midbrain infarction in inherited protein S deficiency: a rare association"],"prefix":"10.1136","volume":"14","author":[{"given":"Manali","family":"Chandra","sequence":"first","affiliation":[{"name":"Internal Medicine, Medical College and Hospital Kolkata, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3809-8926","authenticated-orcid":false,"given":"Atanu","family":"Chandra","sequence":"additional","affiliation":[{"name":"Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8511-6138","authenticated-orcid":false,"given":"Sayantan","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Internal Medicine, Medical College and Hospital Kolkata, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joydeep","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Internal Medicine, Medical College and Hospital Kolkata, Kolkata, West Bengal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"2025082701532172000_14.10.e246073.1","doi-asserted-by":"publisher","DOI":"10.2450\/2010.0066-10"},{"key":"2025082701532172000_14.10.e246073.2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-9560-4-15"},{"key":"2025082701532172000_14.10.e246073.3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.001943"},{"key":"2025082701532172000_14.10.e246073.4","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1212\/WNL.44.11.2032","article-title":"Pure midbrain infarction: clinical syndromes, MRI, and etiologic patterns","volume":"44","author":"Bogousslavsky","year":"1994","journal-title":"Neurology"},{"key":"2025082701532172000_14.10.e246073.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4061\/2011\/209370","article-title":"Epidemiology and etiology of young stroke","volume":"2011","author":"Griffiths","year":"2011","journal-title":"Stroke Res Treat"},{"key":"2025082701532172000_14.10.e246073.6","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.012877","article-title":"Inherited thrombophilia and the risk of arterial ischemic stroke: a systematic review and meta-analysis","volume":"8","author":"Chiasakul","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"2025082701532172000_14.10.e246073.7","doi-asserted-by":"publisher","DOI":"10.1159\/000297966"},{"key":"2025082701532172000_14.10.e246073.8","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1160\/TH08-11-0747","article-title":"Do common prothrombotic mutations influence the risk of cerebral ischaemia in patients with patent foramen ovale? 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