Journal of the Formosan Medical Association
Volume 108, Issue 7 , Pages 592-594, July 2009

Early-onset Stroke in a Patient With Nasopharyngeal Cancer Associated With Protein C Deficiency

  • Ya-Ning Chiu
    • ,
  • Tyng-Guey Wang
    • ,
  • Chein-Wei Chang

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr Chein-Wei Chang, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 1 Chang-Te Street, Taipei, Taiwan

Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan

Received 19 September 2007; received in revised form 28 November 2007; accepted 15 January 2008.

Article Outline

We report a 47-year-old male stroke patient with nasopharyngeal cancer (NPC) and protein C deficiency. The patient was diagnosed with NPC and received a complete course of radiotherapy. Infarction stroke occurred 28 months after radiotherapy and magnetic resonance imaging of the brain confirmed the diagnosis. Carotid duplex sonography showed 50–79% stenosis in his left internal carotid artery. Coagulation profiles indicated protein C deficiency. After medical treatment and rehabilitation, the patient regained the ability to walk and he could perform most of his daily activities. Radiotherapy-induced carotid stenosis is an exacerbating feature of stroke in patients with protein C deficiency. We suggest early carotid duplex sonography and survey of the coagulation profile to prevent a stroke in patients with NPC.

Key Words:  carotid stenosis , nasopharyngeal cancer , protein C deficiency , radiotherapy , stroke

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Dubec JJ , Munk PL , Tsang V , et al.   Carotid artery stenosis in patients who have undergone radiation therapy for head and neck malignancy . Br J Radiol . 1998;71:872–875
  2. Cheng SW , Wu LL , Ting AC , et al.   Irradiation-induced extracranial carotid stenosis in patients with head and neck malignancies . Am J Surg . 1999;178:323–328
  3. Cheng SW , Ting AC , Lam LK , et al.   Carotid stenosis after radiotherapy for nasopharyngeal carcinoma . Arch Otolaryngol Head Neck Surg . 1998;124:517–521
  4. Lam WW , Yuen HY , Wong KS , et al.   Clinically underdetected asymptomatic and symptomatic carotid stenosis as a late complication of radiotherapy in Chinese nasopharyngeal carcinoma patients . Head Neck . 2001;23:780–784
  5. Lam WW , Leung SF , So NM , et al.   Incidence of carotid stenosis in nasopharyngeal carcinoma patients after radiotherapy . Cancer . 2001;92:2357–2363
  6. Fondalstrud EW , Sanchez M , Zerubavel R , et al.   Serial changes in arterial structure following radiation therapy . Surg Gynecol Obstet . 1997;145:395–400
  7. Dorresteijn LD , Kappelle AC , Boogerd W , et al.   Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years . J Clin Oncol . 2002;20:282–288
  8. Haynes JC , Machtay M , Weber RS , et al.   Relative risk of stroke in head and neck carcinoma patients treated with external cervical irradiation . Laryngoscope . 2002;112:1883–1887
  9. Esmon CT . The roles of protein C and thrombomodulin in the regulation of blood coagulation . J Biol Chem . 1989;264:4743–4746
  10. De Stefano V , Finazzi G , Mannucci PM . Inherited thrombophilia: pathogenesis, clinical syndromes, and management . Blood . 1996;87:3531–3544
  11. Kato H , Shirahama M , Ohmori K , et al.   Cerebral infarction in a young adult associated with protein C deficiency. A case report . Angiology . 1995;46:169–173
  12. Martines HR , Rangel-Guerra RA , Marfil LJ . Ischemic stroke due to deficiency of coagulation inhibitors. Report of 10 young adults . Stroke . 1993;24:19–25
  13. Kohler J , Kasper J , Witt I , et al.   Ischemic stroke due to protein C deficiency . Stroke . 1990;21:1077–1080
  14. Sakata T , Kario K , Katayama Y , et al.   Studies on congenital protein C deficiency in Japanese: prevalence, genetic analysis, and relevance to the onset of arterial occlusive disease . Semin Thromb Hemost . 2000;26:11–16

PII: S0929-6646(09)60378-8

doi:10.1016/S0929-6646(09)60378-8

Journal of the Formosan Medical Association
Volume 108, Issue 7 , Pages 592-594, July 2009

Article Tools