Prekallikrein Deficiency Presenting as Recurrent Cerebrovascular Accident: Case Report and Review of the Literature

Abstract

We report the case of a woman with history of hypertension and hyperlipidemia presenting with recurrent episodes consistent clinically with cerebrovascular accidents (CVA), and MRI changes suggestive of ischemia versus vasculitis as their cause. No anatomical neurological, rheumatic, cardioembolic, or arteriosclerotic etiologies could be determined by extensive workup. Incidentally, the patient was found to have prolonged activated Partial Thromboplastin Time (aPTT) and a normal Prothrombin Time (PT); further testing revealed a prekallikrein deficiency. Since no other cause for the CVAs was established, and other prothrombotic states were ruled out, it is proposed that they are clinical manifestations derived from the prekallikrein deficiency, which in a patient with known cardiovascular risk factors could lead to thrombotic complications such as stroke.

Effect of γ-oryzanol on hyperlipidemia and thrombus formation in mice treated with poloxamer-407

“…It can also affect the function of adhesion proteins like fibrinogen, collagen, von Willebrand factors and thereby promote platelet adhesion. 35,36 In our study APTT and PT were reduced in the DI animal group in statistically insignificant manner which were maintained to the normal by pretreatment with OZ which indicates positive effect on both intrinsic as well as extrinsic coagulation process.…”

Prevalence of hypertension and its complications in congenital prekallikrein deficiency

“…Twenty-one out of the 89 patients had hypertension or hypertension-related conditions [6,8,12,14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Twelve were men and nine women (Table 1).…”

Prolonged Activated Clotting Time Immediately Prior to Open Cardiac Surgery

“…Consequently, the deficiency is asymptomatic, with little risk of bleeding. 4 However, rare cases are associated with recurrent mucosal bleeding, 5 hypertension, 6 recurrent cerebrovascular accidents, 7 recurrent pregnancy loss, 8 or failure to progress during labor. 9 Interference with the in vitro measurement of ACT and PTT could cause significant difficulties during the perioperative and postoperative monitoring of anticoagulation that is routinely done with cardiac surgery.…”