[Antiphospholipid antibodies and cerebral ischemia]

Lupus anticoagulants (LAs) and anticardiolipin antibodies (ACAs) are acquired circulating immunoglobulins that cross-react with anionic and neural phospholipids. These factors may display anticoagulant properties in vitro by interfering with phospholipid-dependent coagulation tests. These antibodies are usually not associated with a bleeding tendency. In fact, paradoxically to their name, since the initial recognition they have been related to systemic and cerebral thromboembolisms, despite their in vitro "anticoagulant" properties. We report the clinical and laboratory findings in 4 LAs and ACAs positive patients with brain ischemia.

Antiphospholipid antibodies in cerebral ischemia

In a 2-year prospective study of 146 patients with cerebral ischemia, we compared vascular risk factors for stroke with clinical and laboratory findings, particularly antiphospholipid antibodies. Ten patients (6.8%) were positive for at least one antiphospholipid antibody; one patient had systemic lupus erythematosus, one had rheumatoid arthritis, and the remaining eight fulfilled criteria for the diagnosis of primary antiphospholipid syndrome. These patients were predominantly male, not necessarily young, and 50% of them did not have any other vascular risk factors; there were no significant clinical or paraclinical differences between these patients and those without antiphospholipid antibodies. Outcome in the 10 patients was good, and platelet antiaggregating drugs proved to be useful in preventing further cerebrovascular ischemic events in our patients.

[The clinico-immunological characteristics of patients with severe ischemic brain lesions undergoing combined treatment with the use of intracerebral electrostimulation]

The work analyzes preliminary results of a complex method of treatment of severe ischemic alterations of the brain. Certain parameters of the immune system, its phagocytic link in particular, were studied along with clinico-physiological indices of the functional state of the brain. It was shown that efficient surgical revascularization of the ischemic zones reinforced by electrostimulation at the early postoperative period allowed to substantially restore the motor and speech functions even in cases of critical lesions. Higher indices of functional activity of the phagocytic link of the immune system were noted.

Anticardiolipin antibody and stroke: possible relation of valvular heart disease and embolic events

To establish the etiology of strokes related to the anticardiolipin antibody (Acla) syndrome and to determine the relationship of valvular heart disease and stroke in the presence of the Acla, clinical and objective characteristics of 21 patients with Acla, focal cerebral ischemic events were retrospectively analyzed. Twelve (86%) of 14 patients with stroke and 3 (42%) of 7 patients with non-stroke cerebral ischemic events had echocardiographic evidence of left-sided valvular abnormalities. Features characteristic of cardioembolic stroke were present in 12 (86%) of the 14 patients with stroke. The strength of the association between valvular disease and stroke, combined with the clinical and radiologic features noted, suggest that strokes related to the Acla syndrome typically are embolic, from a cardiac source.

Clinical and laboratory findings in patients with antiphospholipid antibodies and cerebral ischemia. The Antiphospholipid Antibodies in Stroke Study Group

We reviewed the clinical and laboratory data of 128 patients with cerebrovascular disease and antiphospholipid antibodies. Cases were evenly divided between men and women, and the mean age of the study group was 46 years. Cerebral infarction occurred in 97 patients, and transient hemispheric ischemic attacks without stroke were recorded in 19; 12 suffered ocular ischemia. Systemic lupus erythematosus was diagnosed in 16% of all cases. Histories of systemic thromboembolic events and recurrent miscarriages were noted in 14% of the patients and in 19% of the women, respectively. Evidence of cerebral infarction preceding the index event was present in 30% of cases. During a mean follow-up of 16 months, nine of 96 (9%) patients sustained new cerebral infarctions. Of 72 echocardiographic studies, 16 (22%) showed valvular abnormalities. Cerebral angiography detected intracranial lesions in 24 of 49 patients (49%). These data indicate that antiphospholipid antibodies can be identified in stroke patients without known autoimmune disorders. They also suggest that antiphospholipid antibody-associated cerebrovascular ischemia may be recurrent and often occurs in patients with systemic thromboembolic events. Our findings should help design a prospective clinical trial that will assess the risk of recurrent thromboembolism in this population, identify stroke risk factors, and address therapy.

Anticardiolipin antibody associated ischaemic strokes in elderly patients without systemic lupus erythematosus

We describe four elderly stroke patients--two men and two women--who had significantly elevated levels of anticardiolipin antibody in the absence of systemic lupus erythematosus or other connective-tissue disease.

Cardiogenic brain embolism and lupus anticoagulant

The lupus anticoagulant, an acquired immunoglobulin associated with an increased tendency for thrombosis, has been linked to the occurrence of cerebral ischemia presumably related to in situ thrombosis. Cardioembolic cerebral ischemic events have rarely been reported. We encountered 2 patients with focal cerebral ischemia, substantial mitral valvular masses, and a circulating lupus anticoagulant. In each, diagnostic evaluation supported a cardioembolic etiology. These findings illustrate the need for evaluating patients with cerebral ischemic events for a cardioembolic source when a circulating lupus anticoagulant is present.

Lupus anticoagulants, anticardiolipin antibodies, and cerebral ischemia

We studied 23 patients suffering cerebral ischemia who also had laboratory evidence of either a lupus anticoagulant (LA) or an abnormal anticardiolipin antibody (ACA). Four patients had lupus or a lupus-like illness, three had drug-induced lupus, and 16 had no overt evidence of collagen-vascular disease. Cerebral ischemic events were multiple in 71% of the patients; two patients presented with multi-infarct dementia. Recognized cerebrovascular disease risk factors were present in 57% of the patients. The partial thromboplastin time was prolonged in only 35% of the patients. An LA was identified in 15 of 21 patients tested, and an elevated ACA titer was identified in 10 of 12 patients tested. Simultaneous assays for LA and ACA were discordant in eight of 10 patients tested. LA- and ACA-associated brain ischemia is often recurrent, but other risk factors for cerebrovascular disease are often present. The laboratory findings in such patients may display considerable heterogeneity.

[Immunoenzymatic detection of specific brain antigens as a criterion of the permeation of blood-brain barrier in rats with acute cerebral ischemia]

EIA detection system for the measurement of alpha 2 M globulin and GFAP antigen has been developed. The limit of the sensibility was only 1 ng/ml for alpha 2M and 0.8 ng/ml for GFAP. The system was used for the studies of the penetration through the blood-brain barrier in rats with experimental acute brain ischemia. The measurement of alpha 2M and GFAP antigens by EIA technique 16-20 hours after the occlusion of the carotid artery has revealed disturbances in the blood-brain barrier permeability for specific brain proteins. The method is recommended for indirect evaluation of the blood-brain barrier functional disorders.

Changes with age in leucocyte counts, protein and IgG content of lumbar cerebrospinal fluid (CSF) of patients with inflammatory, ischemic, and hemorrhagic diseases or tumors of the central nervous system (CNS)

Parameters of blood-brain barrier (BBB) function and of humoral and cellular immune response were determined in lumbar CSF and blood serum samples from 717 patients and statistically compared to "healthy" controls (n = 190). Leucocyte counts (mainly mononuclear cells), total protein and IgG levels in CSF were significantly higher, and prealbumin fraction mostly lower in patients, besides other alterations of protein electrophoresis. Serum fractions (median) of protein electrophoresis were within the reference range. When parameters were correlated with age, a significant increase of total protein of 1.62 mg/dl and of IgG of 0.13 mg/dl per 10 years of age was found in lumbar CSF of controls. Elevated leucocyte counts did not correlate with age of patients, but they increased significantly with age, with respect to controls, to a higher extent in patients with polyneuritis, ischemia and injury; they decreased in patients with brain tumors and polyneuropathy. When compared to controls, elevated total protein levels significantly increased with age only with tumors and injury patients. In multiple sclerosis, IgG increased and beta-globulin fraction decreased significantly in CSF with age. The findings point to age-dependent alterations of BBB and immune response only in some patients groups which were different from those of controls.

Ischemic stroke associated with anticardiolipin antibodies

Anticardiolipin antibodies are a group of antiphospholipid autoantibodies seen primarily in patients with systemic lupus erythematosus and other autoimmune diseases. We report 3 patients, 2 without systemic lupus, who suffered ischemic brain infarction associated with these antibodies in the absence of detectable lupus anticoagulant activity. Anticardiolipin antibodies, possibly associated with a lupus anticoagulant-like thrombotic tendency, may be a newly recognized cause of ischemic stroke.

A combined method for measurement of cerebral blood flow and immunohistochemistry for investigation of cerebral ischemia

A combined method was established where measurement of cerebral blood flow (CBF) by quantitative autoradiography and detection of morphologic ischemic damage by immunohistochemistry could be accomplished simultaneously with the same brain. The method was applied to the gerbil brain 15 min after occlusion of the right common carotid artery which demonstrated that the reduction of focal CBF can be heterogenous at an early ischemic period, that the residual focal CBF was below 8.0 ml/100 g/min in some areas with ischemic lesions but other areas were tolerant of severe hypoperfusion. The results also suggested that the pathophysiological mechanism of selective tissue vulnerability might be different from one site to another in cerebral ischemia. This method will be useful for autoradiographic measurement of other physiological and biochemical parameters in combination with the immunohistochemical method for demonstration of not only the structural damage, but also the alteration of cell-specific functions.

The spectrum of neurologic disease associated with antiphospholipid antibodies. Lupus anticoagulants and anticardiolipin antibodies

Lupus anticoagulants and anticardiolipin antibodies are antiphospholipid immunoglobulins, predominantly of the IgG, IgM, or mixed class. Recently, these antiphospholipid autoantibodies have been associated with neurologic conditions including focal cerebral and ocular ischemia, the myelopathy of lupoid sclerosis and Degos' disease, Guillain-Barré syndrome, migraine, chorea, and seizures. We review the neurologic manifestations associated with this group of antibodies. Recognition of these conditions may lead to further insights into pathogenesis and therapy.

Is urinary infection a risk factor for ischemic cerebrovascular disease?

The hypothesis is put forward that urinary infection is a risk factor for ischemic cerebrovascular disease (ICVD). Bacteriuria exceeding 10(5) units/ml actually occurred in 68% of the patients with ICVD while a similar number of bacteria was detected only in 12% of the age-matched control subjects. An increased concentration of circulating immune complexes was found in infected patients but the investigated hemostatic variables (plasma fibrinogen and factor VIII related antigen, platelet count and adhesiveness as well as dilute blood clot lysis time) did not significantly differ from patients with ICVD but no urinary infection. Although circulating immune complexes are able to cause endothelial lesions, further investigations on the hemostatic balance are required in order to substantiate the above mentioned hypothesis.

Oligoclonal immunoglobulin G in acute subarachnoid hemorrhage and stroke

Oligoclonal Ig bands were found in serum and CSF of 13 of 83 patients (16%) with verified subarachnoid hemorrhage (SAH). Serum Ig bands were more common in patients with SAH than in those with cerebral ischemia. The reverse was true with oligoclonal Ig bands in CSF. These patterns suggest that there are two different mechanisms and sites of IgG synthesis: an inflammatory process after acute stage of vascular damage and a latent immunologic process--ie, polyclonal B-cell activation by injury to the brain.

Immunohistochemical investigation of cerebral ischemia in gerbils

Experimental cerebral ischemia was produced in gerbils by occlusion of the right common carotid artery in the neck. The evolution of the ischemic lesions was followed from five minutes to six hours by using the immunohistochemical techniques for tubulin and creatine kinase BB-isoenzyme. The earliest lesion was found in the subiculum-CA1 and CA2 regions of the hippocampus in five minutes. There was loss of staining in the apical dendrites and perikarya of the pyramidal cells. The earliest lesion in the cerebral cortex, visible in ten minutes, was a laminar loss of staining for tubulin. Evolution of the ischemic lesions in the thalamus and caudoputamen was delayed. However, in two hours widespread ischemic lesions were seen there. Evolution of the ischemic lesions was slightly slower with the reaction for creatine kinase BB-isoenzyme as compared to the reaction for tubulin, but was far more sensitive than hematoxylin-eosin staining. The distribution of ischemic lesions detected by the immunohistochemical method compared to ischemic areas detected by an India ink perfusion study suggested that both the extent of regional ischemia and regional difference in tissue vulnerability were contributing factors for the emergence of early ischemic lesions. The mechanism for prompt disappearance of the immunohistochemical reaction for tubulin is not clear, but the present investigation demonstrates the usefulness of the immunohistochemical technique for detecting early ischemic lesions and provides a possible biochemical mechanism for cellular damage after ischemic insults.

[Central nervous system manifestations in patients with systemic lupus erythematosus. Review of pathogenetic aspects]

CNS manifestation is considered as a diagnostic as well as prognostic important variation of SLE course. Disturbances of blood flow and immunopathologic process participate in its induction. Antineuronal antibodies and circulating immune complexes in liquor show tight relations to CNS involvement.

[Cerebral ischemia and synthetic estrogens. The role of immunologic mechanisms. Apropos of 2 cases]

The authors report 2 cases of stroke in 2 young women using oral contraception with production of anti-ethinyl-oestradiol antibodies. From literature, they recall the mechanisms of production of theses antibodies, their frequence in women with and without stroke and the different hypothesis lied to their pathogen action.

[Immunoglobulins A, M, and G in the cerebrospinal fluid of patients with ischemic stroke]

In 70 cases of ischaemic brain strokes and 25 cases serving as a reference group the levels of immunoglobulin A, M, G were determined in the cerebrospinal fluid. The obtained results demonstrated that in the studied group the mean levels of IgA and IgM and total protein were increased in the cerebrospinal fluid. The value of IgG was unchanged in relation to the control group. The rise in the mean levels of IgA and IgM was not always parallel with the rise in the total protein level. The authors discuss the importance of blood-brain barrier. Its role seems plausible in cases with raised levels of immunoglobulins and total protein. These changes in the levels of immunoglobulins can be a result of various concomitant local and systemic factors.

[Evaluation of immunologic reaction of the body in patients with acute cerebrovascular diseases by means of the rosette test]

In 63 patients with brain ischaemia and 29 healthy subjects the rosette test was done and clinical observations were conducted parallelly. The percent of peripheral blood lymphocytes forming rosettes spontaneously was 53.7% in the group of patients, while in the control group it was 63.4%. The difference was statistically significant.