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A 14 year old nondiabetic, nonhypertensive boy was admittedwith left sided hemiparesis. He has been diagnosed with ischemic stroke due to combined deficiency of protein S and factor V.Inherited thrombophiliadue to deficiencies of natural anticoagulants (antithrombin, protein C and protein S) and activated protein C resistance (APC-R) are more commonly associated with venous rather than arterial thrombosis. While deficiency of factor V leads to heamorrhage, some mutations like factor V Leiden predispose for thrombosis .Combined deficiency of both protein C and factor V leading to arterial thrombo-embolism causing ischemic stroke is a rarer event.