Ischemic Stroke in a Young Adult Patient: Excess of Factor VIII

Abstract

Aims: Ischemic stroke in young adult patients is an increasing public health problem. Hypercoagulability states and thrombophilia are both rare conditions behind ischemic strokes in young patients. We report a case of ischemic stroke in a young patient due to an excess of factor VIII. Presentation of Case: A 38-year-old woman with a medical history of depression treated with Clomipramine was admitted to the emergency room for coma. The initial brain CT-Scan showed an image of a spontaneously hyper dense basilar artery, and brain MRI found a right occipital and left capsule-thalamic ischemic stroke with total occlusion of the basilar arterial trunk. A standard biological assessment has been performed showing an isolated elevation of factor VIII level at 200%. Discussion: Approximately 80% of all strokes are ischemic strokes. Thrombophilic disorders and their contribution to the stroke risk are uncommon and factor V Leiden mutation accounts for almost half of the thrombophilic states. Case-control studies have suggested an association between elevated levels of FVIII and cryptogenic stroke in particular, which was nearly four times higher in people with elevated FVIII. Conclusion: Factor VIII excess is a recently described, apparently common, and under-recognized cause of hypercoagulability. This case should make consider the fact that ischemic stroke is not only a pathology of the old subject. Also, it highlights the implication of excess in factor VIII in the states of hypercoagulability as a cause of young patient’s ischemic stroke.