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Is Hormone Replacement a Risk Factor for Ischemic Stroke in Women With Factor V Leiden Mutation?
James F. Meschia, MD;
José Biller, MD;
Thomas Witt, MD;
Anne Greist, MD;
Steve N. Rhinehart, MD
Arch Neurol. 1998;55:1137-1139.
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.
Design A case report.
Setting A tertiary care center.
Patient 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 nonenhancing 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.
Main Outcome and 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.
From the Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, Fla (Dr Meschia); Departments of Neurology (Dr Biller), Surgery, Section of Neurological Surgery (Dr Witt), and Medicine, Section of Hematology (Dr Greist), Indiana University School of Medicine, Indianapolis; and Fort Wayne Medical Oncology-Hematology, Fort Wayne, Ind (Dr Rhinehart).
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