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INTRODUCTION:Patients with nephrotic syndrome (NS) are prone to thrombo-embolic phenomena. Acute ischemic stroke is a rare complication of NS & not widely reported in the literature. We report this case to illustrate the importance of considering hypercoagulability from NS as a potential cause of embolic stroke & to initiate anticoagulation treatment. CASE REPORT: A 10year girl presented with headache for 15 days followed by sudden onset left sided weakness during 3^rd relapse of NS. She was diagnosed with NS 1 year back .Medication history at the time of presentation included tablet prednisolone since 10 days of 3^rd relapse. Her vitals were stable with facial puffiness. Neurologic exam showed UMN left facial weakness & left sided weakness. Laboratory tests showed proteinuria & hypercoagulable workup was normal. Renal vein & femoral vein Doppler were normal.MRI brain showed Diffusion restriction in right fronto-parietal region & basal ganglia suggestive of Right MCA territory. CTvenoangiogram brain showed thrombus in Right ICA with normal venogram. Given the  ischemic  infarcts, NS was considered likely etiology ,anticoagulation initiated patient & weakness improved. DISCUSSION: In this case of acute embolic stroke in the setting of NS with a normal coagulation profile & cardiac workup. As the likelihood of hypercoagulability secondary to NS was high, started  on anticoagulation. Arterial thrombosis is rare & more common in the pediatric patient but described in the femoral arteries commonly not in cerebral vasculature. CONCLUSION: In patients with ischemic stroke with concomitant nephrotic syndrome, anticoagulation for the secondary prevention of stroke should be considered.

nephrotic syndrome, ischemic stroke,anticoagulation,angiography