Antiphospholipid Antibody Syndrome With Associated Stroke And Increased Intracranial Pressure.
J Patel, X Tang, R Sultan
J Patel, X Tang, R Sultan. Antiphospholipid Antibody Syndrome With Associated Stroke And Increased Intracranial Pressure.. The Internet Journal of Rheumatology. 2009 Volume 6 Number 2.
Rheumatologists often evaluate patients with Antiphospholipid antibodies; IIH has been reported in patients with antiphosholipid antibodies with or without thrombo- occlusive events. Exact pathogenesis of IIH in patients with antiphospholipid antibody syndrome is not known. We report a case of 15-year-old female presents with numbness of both hands for 5-6 months. Initial MRI revealed non-specific white matter changes but MRA of head and MRI of neck were not revealing. Laboratory data showed anticardiolipin antibodies and elevated sedimentation rate titer. Subsequently the patient developed unilateral right upper extremity numbness, slurred speech with right facial droop. Cerebral angiography revealed occlusion of the left middle cerebral artery. Lumbar puncture revealed intracranial opening pressure of 47 cm H2o, labs with normal cell count, glucose and protein. Patient’s symptoms improved and she was discharged on aspirin. More research is needed to establish the relationship between IIH and anticardiolipin antibodies.
A 15 year old Caucasian female developed numbness in her left hand in November 2007 that quickly resolved; subsequently in May 2008 she developed a transient left sided hemiparesis. This was followed by progressive left hand weakness with a loss of fine motor function. She also had some difficulty in speech with episodes of dysphasia; numbness over left hand was persistent. A neurological exam was normal. MRI of the brain showed some non-specific white matter changes, non enhancing MRA was normal. Her lab showed Elevated sedimentation rate (32), low platelets (142), positive anticardiolipin antibodies (IgG-74, IgM-10), positive Lupus anticoagulant (63.8), Negative ANA, normal hypercoagulability profile and unremarkable basic labs.(Table-1)The patient was admitted in hospital for slurred speech, weakness of the right hand and right facial droop which lasted>24 hours. Cerebral angiogram was done. Left cerebral angiogram showed a focal area of occlusion in a branch of the middle cerebral artery(Figure-1), right cerebral angiogram was normal. Patient underwent a lumbar puncture, which revealed increased intracranial pressure of 47cm H2o. It raised the possibility of pseudotumor like syndrome. Her CSF studies were unremarkable. Patient was started on low dose aspirin; her symptom improved and she was discharged home on baby aspirin.
Cerebral artery distally.
Antiphospholipid antibodies are those that prolong phospholipids dependent coagulation assays, can be categorized in to lupus anticoagulant and anticardiolipin antibodies. The antiphospholipid antibodies and stroke study group (APASS), a consortium of 15 medical centers previously reported that the presence of anticardiolipin antibody is an independent risk factor for first ischemic stroke (4). Arterial thromboembolism in the antiphospholipid antibody syndrome most commonly involves the cerebral circulation with stroke being the initial clinical manifestation in 13% and transient ischemic attack in 7% of the patients (6). Based on APASS data, patients with a first ischemic attack and a single positive antiphospholipid antibody test (
Anticardiolipin antibodies have been associated with idiopathic intracranial hypertension
Investigate the mechanism of the relationship between antiphospholipid antibodies and idiopathic intracranial hypertension before we could routinely recommend screening patients with idiopathic intracranial hypertension for antiphospholipid antibodies.