Stroke and familial protein S deficiency.

To the Editor: We have read with special attention the letter of Davous et al. Because the association between hereditary protein S deficiency and cerebral arterial thrombosis is controversial,' we are reporting another case with this same association in which other members of the family were affected by arterial thrombotic diseases. A 44-year-old man was admitted to our hospital a few hours after noticing dizziness, left facial sensory symptoms, a hoarse voice, and deglutory troubles. Past medical history was unremarkable for vascular risk factors or thrombotic episodes. On examination, neurological deficits were compatible with a left lateral medullary syndrome. Further investigation, including chest x-ray, electrocardiography, and echocardiography, were normal. Cranial computed axial tomography at the earlier stages of the clinical picture was normal. On Doppler examination, a left vertebral artery was not found, but other extracranial arteries were normal. A total occlusion of the left vertebral artery was confirmed by arteriography.