Elevated LpA has been associated with an increased risk of ischemic strokes in adults. In children, the risk has not been well established. It is also unclear whether concomitant thrombogenic factors potentiate this risk. We present a case of a 7-year-old girl with left MCA stroke due to elevated LpA and heterozygous factor V Leiden mutation.

Case Report and Review of Literature

7-year-old healthy girl presented to our institution for acute left MCA territory ischemic stroke (involving basal ganglia, corona radiata and superior temporal lobe) as seen on magnetic resonance imaging (MRI) of the brain manifesting as right hemiparesis, expressive aphasia, and National Institute of Health Stroke Scale (NIHSS) score of 8. Her last known well was 2 hours prior to presentation. Patient received tissue plasminogen activator (tPA) and was admitted to the pediatric ICU for close monitoring. Initial stroke work-up including lipid profile and transthoracic echo was normal. Hypercoagulable profile was drawn to further investigate the stroke etiology. Patient was discharged on Aspirin 81 mg with outpatient follow-up in pediatric stroke clinic. Within 2 weeks, patient’s hypercoagulable panel showed significant elevation of LpA at 201.8 nmol/l (normal <75 nmol/l) and heterozygous mutation of factor V Leiden. Repeat LpA was persistently elevated 4 months later at 200 nmol/l. Patient was seen in the stroke clinic 6 months later with full recovery.

Elevated LpA is associated with increased risk of arterial ischemic strokes given its atherogenic potential in adults. This association is less robust in children. Moreover, concomitant thrombogenic factors including factor V Leiden mutation can likely potentiate this risk. More studies need to be done in this regard to establish the true risk.