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Stroke and aggravation of protein S deficiency: case report A 20-year old woman experienced a stroke and aggravation of protein S deficiency during treatment with ethinylestradiol/ desogestrel for polycystic ovarian syndrome. The woman, whose medical history was notable for menstrual irregularity since the age of 13 years, had been receiving unspecified combined oral contraceptive pills (COCP; inconsistent use). She was later diagnosed with polycystic ovarian syndrome; hence, she receiving oral contraception with oral ethinylestradiol/desogestrel 20µg/0.15mg pills. However, she subsequently presented with sudden-onset difficulty walking, swaying of the body towards the right and double vision for near sight, as well as while looking up or down, accompanied by intermittent upper-limb and facial weakness for a few days. Her family history was notable for her grandfather experiencing a stroke. On examination, she was well-oriented, with stable vitals. Examination of cranial nerves was normal apart from combined third, fourth and sixth nerves, which showed a wide palpebral fissure and superior gaze palsy. She exhibited binocular vertical diplopia and truncal with right gait ataxia. Brain MRI showed two foci of diffusion restriction in left medial thalamus and tegmentum of left hemi-portion of the midbrain, indicating infarction, which was thought to be secondary to ethinylestradiol/desogestrel. Multiple other investigations were unremarkable, apart from decreased functional protein S levels of 23%, indicating hereditary insufficiency (primary deficiency), which was thought to have been aggravated by ethinylestradiol/ desogestrel. Tests also revealed thrombophilia secondary to functional protein S deficiency [duration of treatment to reactions onsets not stated]. Therefore, the woman’s ethinylestradiol/desogestrel pills were discontinued, and she was treated with aspirin and clopidogrel. She made a complete recovery after a few days. Follow-up tests 3 months later showed improvement in functional protein S levels from 23% to 46%. Shah K, et al. A stroke in a young girl on oral contraceptive pills with primary protein S deficiency. Obstetrics and Gynaecology Forum 30: 33-34, No. 1, 2020. Available 803499966 from: URL: https://www.scopus.com/record/display.uri?eid=2-s2.0-85088535838&origin=inward&txGid=a72620473d0ba32c71da1e07cc8259d3#references

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