Keywords: stroke; ischemic strokes; factor V; mutation.
This report underscores the importance of a comprehensive approach involving various diagnostic modalities and the need for considering genetic factors as a cause for young onset ischemic stroke as

1 INTRODUCTION

Factor V Leiden mutation is one of the important genetic risk factors known for spontaneous thrombosis.1 Its mutation causes activated protein C resistance.2 This mutation also potentiates the effect of methylenetetrahydrofolate reductase (MTHFR) causing hyperhomocysteinemia, a known risk factor for blood clot.3 A combined mutation of both has been reported in 0.02%.4 Although rare, it has been found to be associated with young individuals but the combined mutation has rarely been reported. To contribute to the understanding, we present a case of factor-V R506Q and methylenetetrahydrofolate reductase-C677T mutation with left lacunar thalamic infarction of a 25-year-old male who presented with twelve-hour history of ringing sensation of right side of his body who was managed with direct oral anti-coagulation drug which prevented further thrombosis and significant improvement of his symptoms.5