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Abstract Arterial ischemic stroke defines as a new focal neurologic deficit that lasted 24 hours or longer. Stroke is relatively rare in children and incidence of cerebrovascular disease is 1 per 4000 in neonates and 1 per 7000 to 1 per 70000 in older children (1 month to 18 years). Protein S deficiency is one of the causes of the stroke in children. Major manifestations of protein S deficiency are deep venous thrombosis, superficial thrombophlebitis, and pulmonary emboli. The pathogenesis of vascular occlusion in patients with protein S deficiency is unknown. The prevalence of protein S deficiency is between 1% to 7% for first episode of deep venous thrombosis. We present a case of the 6-year-old boy with a history of tonic clonic sizure within a period of 3 years. He subsequently developed acute aphasia and right hemiparesis. Brain magnetic resonance imaging revealed lacunar infarction. Laboratory finding showed that low level of total protein S. The patient was treated with intravenous heparin and patient completely improved. There are no evidence based strategies for the treatment of children with prothrombotic abnormality (because of the lack of research on this subject). How ever this patient completely improved and discharged with oral anticoagulant.

Keywords: Pediatric, protein S deficiency, CVA

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