Cerebral thrombosis in a postmenopausal woman on HRT

Summary We report stroke in a 62-year-old woman who had been on hormone replacement therapy (HRT), estrogen plus progestin, for more than 8 years. She experienced two episodes of transient ischemic attack (TIA), manifesting as right-sided weakness, that persisted for 10–20 min. Magnetic resonance angiography (MRA) obtained before complete stroke, demonstrated severe stenosis of the left middle cerebral artery, without evidence of cerebral infarction. Twenty days after the TIA she suffered a complete stroke corresponding with the site of stenosis. Her protein S activity was low 29%. In the context of the recent findings of the US Women’s Health Initiative, we concur that the safety of long-term HRT should be considered carefully, especially in women with a history of TIA and confirmed cerebral artery stenosis.