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Douglas VP, Rachapudi SS, Davila-Siliezar P, Laylani NAR, Lee AG. Transient Monocular Visual Loss (Amaurosis Fugax): How Does Age Impact Diagnosis? Ophthalmol Ther 2024; 13:1417-1425. [PMID: 38587773 PMCID: PMC11109035 DOI: 10.1007/s40123-024-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Transient monocular visual loss (TMVL), also known as transient monocular blindness or amaurosis fugax ("fleeting blindness"), is a temporary loss of vision often due to ischemia to the retina. While acute TMVL should be considered an emergency that further requires exhaustive investigation, there are some cases in which TMVL arises secondary to benign causes. Age has a major impact in the diagnosis of ischemia and although the differential diagnosis of TMVL can be broad, timely and appropriate history, examination, diagnostic testing, and treatment can be vision- or life-saving. We review the causes of TMVL and the impact of age on the differential diagnoses and management.
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Affiliation(s)
| | - Sruti S Rachapudi
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA
| | - Noor A R Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA
| | - Andrew G Lee
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Texas A and M College of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Vodopivec I, Cestari DM, Rizzo JF. Management of Transient Monocular Vision Loss and Retinal Artery Occlusions. Semin Ophthalmol 2016; 32:125-133. [DOI: 10.1080/08820538.2016.1228417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ivana Vodopivec
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
| | - Dean M. Cestari
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
| | - Joseph F. Rizzo
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
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3
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Affiliation(s)
- CS Lau
- University Department of Medicine, Queen Mary Hospital, Hong Kong
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5
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Dahle C, Vrethem M, Olsson JE, Ernerudh J. High level of anticardiolipin antibodies is an unusual finding in an unselected stroke population. Eur J Neurol 2011; 2:331-6. [DOI: 10.1111/j.1468-1331.1995.tb00135.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Bielory L, Kupersmith M, Warren F, Bystryn J, Frohman L. Skin biopsies in the evaluation of atypical optic neuropathies. Ocul Immunol Inflamm 2009; 1:231-42. [DOI: 10.3109/09273949309085023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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7
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Cervera R, Espinosa G. Unusual manifestations of the antiphospholipid syndrome. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Cecità monoculare transitoria. Neurologia 2009. [DOI: 10.1016/s1634-7072(09)70508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Antiphospholipid syndrome (APS) is primarily considered to be an autoimmune pathological condition that is also referred to as "Hughes syndrome". It is characterized by arterial and/or venous thrombosis and pregnancy pathologies in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disease or secondary to a connective tissue disorder, most frequently systemic lupus erythematosus (SLE). Damage to the nervous system is one of the most prominent clinical constellations of sequelae in APS and includes (i) arterial/ venous thrombotic events, (ii) psychiatric features and (iii) other non- thrombotic neurological syndromes. In this overview we compare the most important vascular ischemic (occlusive) disturbances (VIOD) with neuro-psychiatric symptomatics, together with complete, updated classifications and hypotheses for the etio-pathogenesis of APS with underlying clinical and laboratory criteria for optimal diagnosis and disease management.
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Affiliation(s)
- Penka A Atanassova
- Department of Neurology, Medical University, 15A V. Aprilov Blvd., Plovdiv, 4000, Bulgaria.
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11
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Abstract
Ocular migraine, an uncommon cause of transient monocular visual loss, is an entity physicians should be able to recognize in order to provide appropriate treatment and to avoid unnecessary testing. The following text provides an overview of ocular migraine, including discussion of accepted terminology, clinical presentation, and pathophysiology. An ocular and systemic differential diagnosis, appropriate evaluation, therapy, and prognosis are also discussed.
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Affiliation(s)
- Shilpi Pradhan
- Departments of Ophthalmology and Neurology, Saint Louis University School of Medicine, 1755 South Grand Boulevard, Saint Louis, MO 63104, USA
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12
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Collagen Vascular and Infectious Diseases. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Asherson RA, Cervera R. Unusual manifestations of the antiphospholipid syndrome. Clin Rev Allergy Immunol 2003. [PMID: 12794262 DOI: 10.1385/criai] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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Affiliation(s)
- Ronald A Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine, Cape Town, South Africa
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Abstract
The classical clinical picture of the antiphospholipid syndrome (APS) is characterized by venous and arterial thromboses, fetal losses and thrombocytopenia, in the presence of antiphospholipid antibodies (aPL), namely lupus anticoagulant (LA), anticardiolipin antibodies (aCL), or antibodies to the protein "cofactor" b2 glycoprotein I. Single vessel involvement or multiple vascular occlusions may give rise to a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual and the time interval between them also varies considerably from weeks to months or even years. Deep vein thrombosis, sometimes accompanied by pulmonary embolism, is the most frequently reported manifestation in this syndrome. Cerebrovascular accidents-either stroke or transient ischemic attacks-are the most common arterial thrombotic manifestations. Early and late fetal losses, premature births and pre-eclampsia are the most frequent fetal and obstetric manifestations. Additionally, several other clinical features are relatively common in these patients, i.e., thrombocytopenia, livedo reticularis, heart valve lesions, hemolytic anemia, epilepsy, myocardial infarction, leg ulcers, and amaurosis fugax. However, a large variety of other clinical manifestations have been less frequently described in patients with the APS, with prevalences lower than 5%. These include, among others, large peripheral or aortic artery occlusions, Sneddon's syndrome, chorea, transverse myelopathy, intracardiac thrombus, adult respiratory distress syndrome, renal thrombotic microangiopathy, Addison's syndrome, Budd-Chiari syndrome, nodular regenerative hyperplasia of the liver, avascular necrosis of the bone, cutaneous necrosis or subungual splinter hemorrhages. In this article, some of these "unusual" manifestations are reviewed.
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Affiliation(s)
- Ronald A. Asherson
- Rheumatic Diseases Unit, Department of Medicine, University of Cape Town School of Medicine, Cape Town, South Africa
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
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Srinivasan SK, Pittelkow MR, Cooper LT. Recombinant tissue plasminogen activator for the treatment of cutaneous infarctions in antiphospholipid antibody syndrome: a case report. Angiology 2001; 52:635-9. [PMID: 11570663 DOI: 10.1177/000331970105200908] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antiphospholipid antibody syndrome (APAS) commonly presents with cutaneous infarctions mimicking thromboembolic vaso-occlusive disease. Systemic anticoagulation is the standard of care for this disorder, but treatment failures can occur. The authors report the first successful treatment of cutaneous infarctions due to APAS with low-dose, intravenous tissue plasminogen activator (rTPA) in a patient who failed to improve with high-dose anticoagulation. Wound healing was associated with a marked improvement in blood flow as assessed by scanning laser Doppler. The authors recommend that patients presenting with cutaneous infarctions in the absence of atherosclerosis be evaluated for APAS, and that fibrinolytic therapy be considered if cutaneous infarction persists despite anticoagulant therapy.
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Affiliation(s)
- S K Srinivasan
- Department of Dermatology, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Sayama T, Inamura T, Morioka T, Inoha S, Nakamizo A, Ikezaki K, Matsushima T, Sasaki M, Fukui M. Positron-emission tomography in stroke associated with antiphospholipid syndrome. Radiography (Lond) 2001. [DOI: 10.1053/radi.2001.0329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Giorgi D, David V, Afeltra A, Gabrieli CB. Transient visual symptoms in systemic lupus erythematosus and antiphospholipid syndrome. Ocul Immunol Inflamm 2001; 9:49-57. [PMID: 11262668 DOI: 10.1076/ocii.9.1.49.3980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To review the potential pathogenic mechanisms of transient visual symptoms (TVS) in the course of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), to discuss the most common clinical features associated with the occurrence of TVS, and to explore possible treatment options for these patients. METHODS The literature regarding the clinical and laboratory characteristics of SLE and APS patients experiencing TVS is reviewed from 1979 onward. A brief review of the wide spectrum of ophthalmologic features occurring in SLE and APS is also provided. RESULTS Data emerging from the review process point to thromboembolism as the most probable cause of TVS in SLE and APS. Thromboembolisms are likely induced by cardiac valve abnormalities and should be treated with anticoagulant drugs. CONCLUSION While progress has been made in understanding the association of TVS with SLE and APS, further investigation is needed to clarify this interesting relationship.
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Affiliation(s)
- D Giorgi
- Lupus Eye Research Unit, Institute of Ophthalmology, 'La Sapienza' University, Rome, Italy.
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Kent D, Hickey-Dwyer M, Clark D. Long-term follow-up of ischaemic retinopathy in the antiphospholipid syndrome with lupus-like disease. Eye (Lond) 2000; 14 ( Pt 3A):313-7. [PMID: 11026991 DOI: 10.1038/eye.2000.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Antiphospholipid syndrome (APS), as an acquired prothrombotic disorder, is increasingly being recognised as an important cause of systemic venous and arterial thrombosis. The defining feature of the condition is the presence of raised levels of antibodies to negatively charged phospholipids in the serum. METHODS We describe 2 cases of APS with ocular involvement and review the recent literature. Both patients experienced acute visual loss. It was the presenting symptom in one case--a finding that led to the diagnosis of the syndrome. RESULTS Management with anticoagulation therapy, in which the International Normalised Ratio (INR) has been maintained at or above 3, resulted in reperfusion of the ischaemic retina and stabilisation of the retinopathy in one patient, whilst in the other case, where the INR was less than 3, irreversible visual loss occurred. CONCLUSION Anticoagulation with warfarin appears to result in reperfusion of ischaemic retina with stabilisation of the neovascular process when the INR is greater than 3.
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Affiliation(s)
- D Kent
- Department of Ophthalmology, Countess of Chester Hospital, UK
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Yamakuchi M, Tanaka S, Tomosugi T, Moroki K, Yamada M, Toujou H, Uetsuhara K, Maruyama I. Pulmonary arteriovenous fistula manifesting as amaurosis fugax--case report. Neurol Med Chir (Tokyo) 2000; 40:264-7. [PMID: 11980092 DOI: 10.2176/nmc.40.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pulmonary arteriovenous fistula (PAVF) is a rare condition which occasionally causes neurological complications. A 43-year-old female with multiple PAVFs presented with several episodes of amaurosis fugax and transient right hemiparesis. She had no other vascular abnormality, and her human leukocyte antigen haplotype did not coincide with previous patients with hereditary hemorrhagic telangiectasia. She underwent PAVF embolization to prevent further neurological complications, and had an uneventful subsequent clinical course. Amaurosis fugax is a slight neurological symptom and may be an early important sign of PAVF. We stress that PAVFs should be considered in the differential diagnosis of patients with amaurosis fugax who complain of exertional dyspnea or demonstrate cyanosis.
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Affiliation(s)
- M Yamakuchi
- Department of Molecular Laboratory Medicine, Kagoshima University School of Medicine
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20
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Abstract
Congenital and acquired hypercoagulable states arise from an imbalance between procoagulant and anticoagulant forces. Although these conditions are present throughout the vascular tree, they typically give rise to local thrombotic lesions in discrete segments of the veins or arteries; this suggests that focal defects in the vascular wall or blood flow must be associated with a hypercoagulable state to produce thrombosis. Numerous new factors associated with hypercoagulability have been described in the past few years. Congenital and acquired hypercoagulable states are reviewed here, with an emphasis on recent data on focal thrombosis involving the eye and central nervous system.
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Affiliation(s)
- V Biousse
- Neuro-ophthalmology Unit, Emory Eye Center, Atlanta, GA 30322, USA.
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Montehermoso A, Cervera R, Font J, Ramos-Casals M, García-carrasco M, Formiga F, Callejas JL, Jorfán M, Griñó MC, Ingelmo M. Association of antiphospholipid antibodies with retinal vascular disease in systemic lupus erythematosus. Semin Arthritis Rheum 1999; 28:326-32. [PMID: 10342390 DOI: 10.1016/s0049-0172(99)80017-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To study the prevalence and characteristics of retinal vascular disease in patients with systemic lupus erythematosus (SLE) and to analyze their relationship with antiphospholipid antibodies (aPL) and other serological markers. PATIENTS AND METHODS Eighty-two consecutive patients (77 women and 5 men; mean age, 36 years) were studied. All patients fulfilled the 1982 revised criteria of the American College of Rheumatology for the classification of SLE. Ophthalmologic examination included assessment of best corrected visual acuity, tonometry, slit-lamp biomicroscopy, and fundus examination. Serologic studies included determination of anticardiolipin antibodies (aCL) (ELISA), lupus anticoagulant (LA) (coagulation tests), antinuclear antibodies (indirect immunofluorescence), anti-DNA (Farr's test), and anti-ENA antibodies (counterimmunoelectrophoresis). RESULTS Retinal vascular disease was detected in 13 (15%) of 82 SLE patients. The retinal lesions consisted of retinal vascular occlusions in six patients (five arterial and one venous), cotton-wool spots in three, optic disc edema in three, retinal hemorrhages in three, and ischemic optic neuropathy in one. Antiphospholipid antibodies were detected in 10 (77%) of these 13 patients: nine had aCL and two had the LA. When compared with patients without retinal vascular disease, patients with retinopathy had a higher prevalence of aPL (77% v. 29%, P = .005). CONCLUSIONS Retinal vascular disease is frequent in patients with SLE. The presence of aPL is associated with a higher prevalence of retinal abnormalities in SLE patients.
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Affiliation(s)
- A Montehermoso
- Department of Medicine, Institut d'Investigacions Biomèdiques August Pi I Sunyer, School of Medicine, University of Barcelona, Catalonia, Spain
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Vrethem M, Dahle C, Lindahl T, Ernerudh J. Association between deficiency of free protein S and anticardiolipin antibodies in patients </= 65 years of age with acute ischemic stroke and TIA. Eur J Neurol 1998; 5:491-497. [PMID: 10210879 DOI: 10.1046/j.1468-1331.1998.550491.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A possible association between anticardiolipin antibodies (ACA), which are a marker for increased risk of cerebral ischemia, and deficiency of free Protein S, a naturally occurring anticoagulant, has been suspected in some studies of ischemic stroke, particularly in young adults. In order to investigate this further, we prospectively studied all stroke patients </= 65 years of age admitted to our stroke unit during 1991-1992. A total of 66 patients with acute ischemic stroke or transient ischemic attacks (TIA) (embolic/thrombotic infarction n = 30, embolic infarction n = 13, thrombotic infarction n = 10, and TIA n = 13) were analysed for ACA, protein C and S, free protein S and antithrombin III (AT III). Traditional risk factors were scrutinized in each patient. Eight patients had some previously undetected derangement of the coagulation process; five had elevated ACA levels, four had low, free Protein S levels, and three had low AT III levels. None of the patients showed any decrease in total protein C or S levels. A striking association between the presence of ACA and free protein S deficiency was noted. All patients with free protein S deficiency had concomitant elevated ACA levels. Sixteen patients had had a previous episode of ischemic stroke/TIA or mycocardial infarction, two of them had lowered AT III levels. Thirty-four patients had one or more elevated infectious parameters but with no clear correlation to derangement of the coagulation factors. We conclude that a probable association between ACA and free protein S deficiency exist in ischemic stroke patients, and that it may have a pathogenetic importance. Copyright 1998 Lippincott Williams & Wilkins
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Affiliation(s)
- M Vrethem
- Departments of Neurology, University Hospital, S-581 85, Linkoping, Sweden
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Emmi L, Bergamini C, Spinelli A, Liotta F, Marchione T, Caldini A, Fanelli A, De Cristofaro MT, Dal Pozzo G. Possible pathogenetic role of activated platelets in the primary antiphospholipid syndrome involving the central nervous system. Ann N Y Acad Sci 1997; 823:188-200. [PMID: 9292045 DOI: 10.1111/j.1749-6632.1997.tb48391.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Neurological disorders occurring in the primary antiphospholipid syndrome (neuro-PAPS) have not yet been completely understood. Platelet activation has been suggested to play a crucial role in the pathogenesis of hemostatic disorders in the antiphospholipid syndrome, but no association with neuro-PAPS has been investigated so far. Therefore, we investigated 16 patients with PAPS by flow cytometry in the presence of circulating activated platelets as defined by the surface expression of activation-dependent glycoprotein CD62. In addition, the relationship among activated platelets and anticardiolipin antibodies (aCL) was evaluated. Compared to normal subjects CD62 was found significantly increased in these patients. Furthermore, a significantly increased percentage of CD62-positive platelets was found in the neuro-PAPS group (nine patients) compared to the non-neuro-PAPS patients (seven subjects). On the contrary, no significant difference was found between the two groups with regard to aCL IgG and platelet number. Furthermore, within the neuro-PAPS group, no difference was evidenced, in the CD62-positive platelet percentage, between the four subjects with thrombocytopenia and the five with the normal blood platelet count. Similarly, neuro-PAPS subjects with previous peripheral arterial and/or venous thrombosis did not show a significantly more elevated level of CD62-positive platelets. Finally, a linear correlation was found between the aCL IgG level and the CD62-positive platelet percentage in all the patients and, more significantly, in the neuro-PAPS group, but not within the non-neuro-PAPS patients. Our data demonstrate that circulating activated platelets are detectable by flow cytometry in the majority of PAPS patients and suggest the existence of a relationship among activated platelets, aCL, and neurological disease that patients affected by PAPS might undergo.
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Affiliation(s)
- L Emmi
- Institute of Internal Medicine and Immunoallergology, University of Florence Medical School, Italy.
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Ziporen L, Shoenfeld Y, Levy Y, Korczyn AD. Neurological dysfunction and hyperactive behavior associated with antiphospholipid antibodies. A mouse model. J Clin Invest 1997; 100:613-9. [PMID: 9239409 PMCID: PMC508229 DOI: 10.1172/jci119572] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Antiphospholipid antibodies (aPL) have been associated with various neurological manifestations, but the underlying mechanism has not been elucidated. We assessed mice with induced experimental antiphospholipid syndrome (APS) for neurological and behavioral changes. After immunization with monoclonal human anticardiolipin antibody (H-3), female BALB/c mice developed elevated levels of circulating anti-negatively charged phospholipids (aPL), anti-beta2-glycoprotein I (abeta2GPI), and anti-endothelial cell antibodies (AECA), along with clinical manifestations of APS like thrombocytopenia and fetus resorption. APS mice were impaired neurologically and performed several reflexes less accurately compared to the controls, including placing reflex (P < 0.05), postural reflex (P < 0.05), and grip test (P = 0.05). The APS mice also exhibited hyperactive behavior in an open field, which tests spatial behavior (P < 0.03), and displayed impaired motor coordination on a rotating bar. aPL in combination with abeta2GPI and AECA is probably involved in the neurological and behavioral defects shown in mice with experimental APS.
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Affiliation(s)
- L Ziporen
- Research Unit of Autoimmune Diseases, Department of Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
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Abstract
The antiphospholipid syndrome is an acquired multisystem disorder of hypercoagulation, which may be primary or secondary to underlying diseases. Serologic markers for the syndrome are the lupus anticoagulant and anticardiolipin antibodies. Clinical features include recurrent thrombotic events (arterial or venous), repeated fetal loss, and thrombocytopenia. Cutaneous manifestations may occur as the first sign of antiphospholipid syndrome. These include livedo reticularis, necrotizing vasculitis, livedoid vasculitis, thrombophlebitis, cutaneous ulceration and necrosis, erythematous macules, purpura, ecchymoses, painful skin nodules, and subungual splinter hemorrhages. Antiphospholipid syndrome may also be associated rarely with anetoderma, discoid lupus erythematosus, cutaneous T-cell lymphoma, or disorders that closely resemble Sneddon or Degos syndromes. Noninflammatory vascular thrombosis is the most frequent histopathologic feature observed. Prophylaxis and treatment of thrombosis in patients with antiphospholipid syndrome relies principally on anticoagulant and antiplatelet agents.
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Affiliation(s)
- G E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
A 36-year-old healthy woman developed amaurosis fugax of the right eye lasting 1 minute. Work-up revealed right carotid stenosis thought most compatible with an atherosclerotic plaque. A carotid endarterectomy was performed which corroborated the radiologic diagnosis. An embolic event from ipsilateral carotid artery disease should be considered as a cause of amaurosis fugax even in the young.
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Affiliation(s)
- M L Slavin
- Long Island Jewish-Hillside Medical Center, New Hyde Park, New York, USA
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Nahass GT. Antiphospholipid antibodies and the antiphospholipid antibody syndrome. J Am Acad Dermatol 1997; 36:149-68; quiz 169-72. [PMID: 9039162 DOI: 10.1016/s0190-9622(97)70274-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The antiphospholipid antibody syndrome is a multiple-system disorder characterized by persistently elevated antiphospholipid antibodies and/or arterial or venous thrombosis, thrombocytopenia, or recurrent spontaneous abortion. Anticardiolipin antibodies and the lupus anticoagulant are different classes of antiphospholipid antibodies associated with this disorder. Cutaneous manifestations are common and may be the presenting sign of the underlying disease. This article reviews the clinical manifestations, laboratory assays, histopathologic features, and treatment of the antiphospholipid antibody syndrome.
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Affiliation(s)
- G T Nahass
- Department of Dermatology, St. Louis University Health Sciences Center, MO 63104, USA
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Jacobson MW, Abraham E, Tietjen GE. A review of neurological sequelae and cognitive deficits associated with antiphospholipid antibodies. J Stroke Cerebrovasc Dis 1996; 6:61-6. [PMID: 17894970 DOI: 10.1016/s1052-3057(96)80004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/1995] [Accepted: 01/17/1996] [Indexed: 11/30/2022] Open
Abstract
Antiphospholipid Antibodies (aPAs) are specific circulating immunoglobulins that lead to a hypercoagulant state and recurrent arterial and venous thromboembolic events. The cerebral circulation is the most common site of arterial occlusion in aPAs, and neurologic events include amaurosis fugax, migrainous cephalalgia, transient ischemic attacks (TIA), stroke, ischemic encephalopathy, and vascular dementia. A review of the literature yields numerous studies citing neurocognitive and neuropsychiatric symptoms associated with this syndrome in a much younger population than is seen in other cerebrovascular disorders. These associated features include focal and generalized cognitive deficits, early-onset vascular dementia, and neuropsychiatric symptoms such as affective and thought disorders. These neurocognitive and neurobehavioral manifestations may be underemphasized in this population and aPAs should be considered in a differential diagnosis. Largescale prospective studies are needed to quantify psychiatric and neuropsychological sequelae of this disorder.
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Martens PB, Levine JA, Hunder GG. Splinter hemorrhages following arterial puncture. ARTHRITIS AND RHEUMATISM 1996; 39:169-70. [PMID: 8546727 DOI: 10.1002/art.1780390124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Splinter hemorrhages can be a feature of the antiphospholipid syndrome. We describe a patient in whom splinter hemorrhages developed following radial artery puncture. The implications of this findings in patients with the antiphospholipid syndrome are discussed.
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Affiliation(s)
- P B Martens
- Mayo Clinic, Rochester, Minnesota 55905, USA
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30
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Feldmann E, Levine SR. Cerebrovascular disease with antiphospholipid antibodies: immune mechanisms, significance, and therapeutic options. Ann Neurol 1995; 37 Suppl 1:S114-30. [PMID: 8968222 DOI: 10.1002/ana.410370712] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There has been a recent, dramatic surge in interest in antiphospholipid antibodies and associated clinical disorders, especially focal ischemic cerebrovascular disease. Antiphospholipid antibodies are a heterogeneous group of antibodies with varying specificities. Coagulation assays will detect lupus anticoagulants while enzyme-linked immunosorbent assays detect anticardiolipin antibodies. There are numerous potential links between antiphospholipid antibodies and coagulation disorders, including interaction of antiphospholipid antibodies and a cofactor, beta 2-glycoprotein I, which itself is involved in coagulation mechanisms. While the specific mechanism of antiphospholipid antibody-related coagulopathy is unknown, it is clear that antiphospholipid antibodies are associated with an immune-mediated prothrombotic state. Patients with the highest titers of IgG antiphospholipid antibodies have a relatively high risk of recurrent thrombotic events, especially stroke, deep venous thrombosis, and spontaneous abortion. Because of limited controlled, prospective data, current therapy remains empiric and directed at coagulation mechanisms, immune mechanisms, or both.
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Affiliation(s)
- E Feldmann
- Department of Clinical Neurosciences, Brown University School of Medicine, Providence, RI, USA
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31
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Abstract
What have we learned about CNS lupus in recent years? An enormous amount of knowledge on pathophysiology of antiphospholipid antibodies, in particular, has been gathered. Although hard evidence of a direct pathogenetic role of these antibodies in cerebral lupus is still lacking, it is generally felt that the multiple microinfarctions found in the brains of lupus patients are related to their presence. Better understanding of the pathogenesis of cerebral lupus will come from the study of experimental models, as it has been possible to develop an antiphospholipid antibody syndrome in mice. Because no specific laboratory test for CNS lupus is yet available, diagnosing the condition remains a challenge to every clinician. Techniques including neuropsychometric testing, quantitative EEG, and SPECT scans have taught us more about cognitive dysfunction and psychosis in patients with SLE. These categories remain the most difficult to define. The concept of hypercoagulability in SLE patients has diverted the direction of therapy from immunosuppression towards anticoagulation. It is of utmost importance that randomised trials are commenced in order to determine the optimal mode of anticoagulation for various groups of lupus patients. It will be necessary to conduct such trials under strict inclusion criteria, based on well defined patient categories. Such an enterprise will require international co-operation of investigators.
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Affiliation(s)
- G A Bruyn
- Department of Rheumatology, Medisch Centrum Leeuwarden, The Netherlands
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32
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Cervera R, Asherson RA, Lie JT. Clinicopathologic correlations of the antiphospholipid syndrome. Semin Arthritis Rheum 1995; 24:262-72. [PMID: 7740306 DOI: 10.1016/s0049-0172(95)80036-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Since the original description and definition of the antiphospholipid syndrome (APS), a number of distinct clinical manifestations related to it have appeared in the literature. These include vascular obstruction of both veins and arteries, thrombus formation on the endocardium and its consequences, as well as a group of other conditions where vascular obstructive mechanisms are either incompletely understood or unproven, eg, chorea, avascular necrosis, and pulmonary hypertension. Single vessel (large/medium) involvement or multiple vascular occlusions may cause a wide variety of presentations. Any combination of vascular occlusive events may occur in the same individual, and the time interval between them also varies considerably from weeks to months or even years. Rapid chronological occlusive events occurring over days to weeks have been termed the "catastrophic" APS. Most of these complications may be ascribed to the hypercoagulable state of which antiphospholipid antibodies appear either to be "markers" or intimately connected with the highly complex coagulation mechanisms resulting in thrombotic occlusions.
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Affiliation(s)
- R Cervera
- Department of Internal Medicine, Hospital Clínic, Barcelona, Catalonia, Spain
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33
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Affiliation(s)
- R L Brey
- Division of Neurology, University of Texas Health Science Center at San Antonio 78284-7883
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34
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35
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Francès C, Piette JC, Saada V, Papo T, Wechsler B, Chosidow O, Godeau P. Multiple subungual splinter hemorrhages in the antiphospholipid syndrome: a report of five cases and review of the literature. Lupus 1994; 3:123-8. [PMID: 7920612 DOI: 10.1177/096120339400300212] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Multiple subungual splinter hemorrhages have been initially described as an important sign of subacute endocarditis. Secondly, they were reported in various other conditions, especially in isolated cases of primary antiphospholipid syndrome. We report five patients with multiple fingernail subungual splinter hemorrhages occurring in the course of antiphospholipid syndrome. Antiphospholipid syndrome was secondary to systemic lupus erythematosus in two, to Fasciola hepatica infection in one and was considered as primary in two. In all patients multiple subungual splinter hemorrhages occurred concomitantly with thrombotic events of diverse arterial sites. The mechanism of subungual splinter hemorrhages is most probably thrombotic.
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Affiliation(s)
- C Francès
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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36
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Abstract
The aetiology of non-arteritic ischaemic optic neuropathy (ION) is multifactorial with local anatomical and systemic haemodynamic abnormalities both playing a role. A careful search for treatable vascular disease risk factors is required to allow rational therapy, to optimise the visual prognosis and to allow new insights into pathogenesis. We describe 7 cases in which there was an associated thrombophilic (prothrombotic) state; 4 had deficiencies of the physiological anticoagulants proteins C and S and antithrombin III and 2 had anti-phospholipid antibody (lupus anticoagulant) syndromes. A further patient had reduced levels of the physiological fibrinolytic agent tissue plasminogen activator (t-PA). In 5 patients other risk factors for small vessel occlusive disease were also present, and 4 had recurrent episodes of ION in the same eye. The visual prognosis in these patients may be improved by anticoagulation with warfarin.
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Affiliation(s)
- J F Acheson
- Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, UK
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37
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Braune S, Siekmann R, Vaith P, Lücking CH. Primary antiphospholipid antibody syndrome and cerebral ischemia: report on acute intervention in two cases and literature review with emphasis on therapeutic options. Rheumatol Int 1993; 13:169-74. [PMID: 8310211 DOI: 10.1007/bf00301266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In two patients with primary antiphospholipid antibody syndrome and acute cerebrovascular ischemic events, local intraarterial fibrinolysis and intravenous heparin therapy, respectively, resulted in a limitation of persisting neurological deficits. On the basis of the 35 case reports available a combination of anticoagulation with warfarin, plus immunosuppression with steroids and/or cyclophosphamide or azathioprine, appears to be the best treatment to prevent further cerebral ischemic events. The therapeutic options are reviewed and discussed.
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Affiliation(s)
- S Braune
- Neurologische Universitätsklinik Freiburg, Germany
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38
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Brey RL, Gharavi AE, Lockshin MD. NEUROLOGIC COMPLICATIONS OF ANTIPHOSPHOLIPID ANTIBODIES. Rheum Dis Clin North Am 1993. [DOI: 10.1016/s0889-857x(21)00209-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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Hess DC, Sheppard JC, Adams RJ. Increased immunoglobulin binding to cerebral endothelium in patients with antiphospholipid antibodies. Stroke 1993; 24:994-9. [PMID: 8322401 DOI: 10.1161/01.str.24.7.994] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE There is a strong link between antiphospholipid antibodies and stroke. The mechanism of action of antiphospholipid antibodies is unknown. Most theories of pathogenesis center around platelet or endothelial cell dysfunction. Our aim was to determine if there were immunoglobulins in the sera of patients with antiphospholipid antibodies that bind human brain microvascular endothelial cells. METHODS We studied sera from three groups of subjects: patients with antiphospholipid antibodies and stroke (group 1), healthy control subjects (group 2), and patients with stroke but without antiphospholipid antibodies (group 3). We isolated human brain microvascular endothelial cells from temporal lobectomy specimens and used a cellular enzyme-linked immunosorbent assay (ELISA) to measure immunoglobulin binding to endothelial cells derived from human brain and from human umbilical vein. We used a chromium release assay to measure cytotoxicity. RESULTS Patients with antiphospholipid antibodies and stroke had significantly higher immunoglobulin binding to human brain microvascular endothelial cells than subjects in the other groups ([ELISA index+standard deviation], 63 +/- 37 [group 1] versus 7 +/- 7 [group 2] versus 7 +/- 7 [group 3], P < .001). There was, however, poor correlation between binding to brain endothelial cells and binding to cardiolipin. The binding to brain microvascular cells was not specific to brain endothelium, as similar results were found in an ELISA using human umbilical vein cells. There was no evidence of complement-mediated brain endothelial cell cytotoxicity. CONCLUSIONS Patients with stroke and antiphospholipid antibodies frequently have human brain microvascular endothelial-reactive antibodies in their serum. These antibodies are distinct from those to cardiolipin. We found no evidence that these antibodies are cytotoxic.
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Affiliation(s)
- D C Hess
- Department of Neurology, Medical College of Georgia, Augusta
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40
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41
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Severi S, Ghezzi M, Felici M, Miele A. Antiphospholipid antibodies syndrome and cerebral ischemia. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1993; 14:129-37. [PMID: 8509268 DOI: 10.1007/bf02335747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Antiphospholipid antibodies are acquired circulating immunoglobulins that interact with phospholipids. These factors may manifest anticoagulant properties in vitro, interfering with phospholipid-dependent coagulation tests. They are not, however, associated with a hemorrhagic diathesis. Indeed, far from exerting the anticoagulant properties they possess in vitro, they are associated with episodes of thromboembolism, systemic and cerebral. We report the clinical and instrumental findings in 7 patients with ischemic stroke and circulating antiphospholipid antibodies classifiable as antiphospholipid antibodies syndrome.
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Affiliation(s)
- S Severi
- U.O. Neurologia/Neurofisiopatologia, Ospedale USL 23, Arezzo
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42
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Mokri B, Jack CR, Petty GW. Pseudotumor syndrome associated with cerebral venous sinus occlusion and antiphospholipid antibodies. Stroke 1993; 24:469-72. [PMID: 8446985 DOI: 10.1161/01.str.24.3.469] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Antiphospholipid antibodies are known to be associated with increased risk of venous and arterial thrombotic events, including cerebral venous thromboses. Pseudotumor syndrome can be produced by cerebral venous thrombosis. A patient with cerebral venous thrombosis associated with antiphospholipid antibodies who exhibited pseudotumor syndrome is reported. CASE DESCRIPTION A 49-year-old man who noted visual blurring and persistent vertical wavy lines in his fields of vision was found to have papilledema. Cerebrospinal fluid values were normal except for an opening pressure increase to 510 mm of fluid. His visual symptoms improved with lumbar puncture and the use of acetazolamide. Imaging studies showed that the transverse sinus was occluded completely on the left and partially on the right and that there was a small left cerebellar cortical venous infarction. CONCLUSIONS Antiphospholipid syndrome should be considered in the differential diagnosis of pseudotumor syndrome related to cerebral venous thrombosis.
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Affiliation(s)
- B Mokri
- Department of Neurology, Mayo Clinic, Rochester, MN 55905
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43
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44
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Abstract
The antiphospholipid antibodies (aPL), namely, the lupus anticoagulant and the anticardiolipin antibodies, are a family of autoantibodies directed predominantly against negatively charged phospholipids. Many studies have confirmed that patients with these antibodies are prone to repeated episodes of thrombosis, fetal losses, and thrombocytopenia. The association of aPL with these clinical events has been termed the antiphospholipid syndrome. Several skin lesions have been found in patients with this syndrome, including livedo reticularis, livedoid vasculitis, thrombophlebitis, cutaneous infarctions and gangrene of digits, ulcerations, lesions resembling vasculitis (nodules, macules), cutaneous necrosis/infarctions, subungual splinter hemorrhages, and, less commonly, discoid lupus and Degos' disease (malignant atrophic papulosis). In this article, we review the main immunologic and clinical aspects of this syndrome with special emphasis on the dermatologic features.
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Affiliation(s)
- R A Asherson
- Division of Rheumatology and Connective Tissue Diseases, Roosevelt/St. Luke's Hospital Center, New York, New York 10019
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45
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Severi S, Ghezzi M, Felici M. The primary antiphospholipid syndrome: case report. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1992; 13:599-601. [PMID: 1428795 DOI: 10.1007/bf02233404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lupus anticoagulant antibodies and anticardiolipin antibodies are acquired circulating immunoglobulins that interact with phospholipids. These factors may exert anticoagulant properties in vitro and so interfere with coagulation tests that use phospholipids. These antibodies are not, however, associated with a hemorrhagic diathesis. Indeed, despite their name and their in vitro anticoagulant properties, they have been associated right from the earliest reports with systemic and cerebral thromboembolic episodes. We report the clinical and instrumental findings in a patient with ischemic stroke and anticoagulant antibodies in the serum.
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Affiliation(s)
- S Severi
- U.O. di Neurologia e Neurofisiopatologia, Ospedale USL 23, Arezzo
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46
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Asherson RA, Jacobelli S, Rosenberg H, Mckee P, Hughes GR. Skin nodules and macules resembling vasculitis in the antiphospholipid syndrome--a report of two cases. Clin Exp Dermatol 1992; 17:266-9. [PMID: 1451318 DOI: 10.1111/j.1365-2230.1992.tb02164.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two patients who demonstrated skin lesions in the presence of antiphospholipid antibodies are documented. The first had a long history of recurrent painful nodules. She had also suffered two deep vein thromboses. The second developed a rash on the lower limbs resembling vasculitis which did not respond to prednisolone, but to low dose salicylate therapy. Histology in both patients revealed microthrombosis of cutaneous vessels.
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Affiliation(s)
- R A Asherson
- Lupus/Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London
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47
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Vrethem M, Ernerudh J, Lindström F, Olsson JE. Cerebral ischemia associated with anticardiolipin antibodies. Acta Neurol Scand 1992; 85:412-7. [PMID: 1642113 DOI: 10.1111/j.1600-0404.1992.tb06039.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Eight patients, 3 with systemic lupus erythematosus (SLE) or "SLE-like" disease, 1 with sarcoidosis, and 4 with no connective tissue disease had transient ischemic attacks (TIA) or cerebral infarctions associated with high levels of anticardiolipin antibodies (ACA). Cerebral ischemic events included amaurosis fugax, recurrent hemispheric TIA, cerebral infarction, and multi-infarction dementia. Treatment with acetylsalicylic acid was ineffective in 3 patients. Warfarin, alone or in combination with dipyridamole or steroids, may reduce the risk of further cerebrovascular events.
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Affiliation(s)
- M Vrethem
- Department of Neurology, Linköping University Hospital, Sweden
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48
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Abstract
Antiphospholipid antibodies have been detected in patients with transient neurologic symptoms including migraine aura. The role of these antibodies in the pathogenesis of migraine is not fully understood. The available data suggest an association between the migraine-like phenomena and antiphospholipid antibodies, but not between migraine headache and antiphospholipid antibodies. To elucidate the actual role of antiphospholipid antibodies in migraine, prospective, controlled studies are needed.
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Affiliation(s)
- G E Tietjen
- Department of Neurology, Henry Ford Hospital and Health Sciences Center, Detroit, MI 48202
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49
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Gruber ML, Hochberg FH. Visual scotomata resulting from lupus anticoagulant in a patient with lymphoma in remission. J Neurooncol 1991; 11:255-7. [PMID: 1726657 DOI: 10.1007/bf00165534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Episodic cerebro or retinovascular ischemic events without apparent cause occur in patients with cancer. We report a patient in remission from lymphoma whose multiple episodes of presumed ocular ischemia occurred in the setting of a circulating lupus anticoagulant. Symptoms resolved following therapy with Warfarin.
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50
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Brenner B, Blumenfeld Z, Markiewicz W, Reisner SA. Cardiac involvement in patients with primary antiphospholipid syndrome. J Am Coll Cardiol 1991; 18:931-6. [PMID: 1894866 DOI: 10.1016/0735-1097(91)90749-y] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To evaluate cardiac involvement in primary antiphospholipid syndrome, two-dimensional and Doppler echocardiographic studies were performed in 34 consecutive patients with this syndrome. All patients had an increased level of serum anticardiolipin antibodies with no evidence of malignancy or systemic lupus erythematosus. The clinical manifestations of primary antiphospholipid syndrome were arterial thrombosis in 14 patients, venous thrombosis in 6 and recurrent fetal loss in 14. Valvular lesions were observed on two-dimensional echocardiography in 11 patients (32%) (9 women and 2 men), aged 24 to 57 years (mean +/- 1 SD 36 +/- 10). Abnormal echocardiographic findings were observed in 9 (64%) of 14 patients with arterial thrombosis versus 1 (17%) of 6 patients with venous thrombosis and 1 (7%) of 14 patients with recurrent fetal loss. The most common echocardiographic abnormality was mitral leaflet thickening, found in five patients; this was associated with mitral regurgitation in three and with combined mild mitral stenosis and regurgitation in one patient. Localized subvalvular mitral thickening was observed in one patient and calcification of the anulus in another. Aortic valve thickening was observed in two patients, one of whom also had a moderate degree of aortic regurgitation. Vegetation-like lesions on the mitral or aortic valve were found in two patients. It is concluded that valvular lesions are commonly found in primary antiphospholipid syndrome, particularly when the syndrome is manifested by peripheral arterial thrombosis. The location and appearance of valvular lesions in this syndrome are heterogeneous. Most patients have no clinically significant valvular disease. Two-dimensional and Doppler echocardiographic studies are often informative in these patients.
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Affiliation(s)
- B Brenner
- Department of Hematology, Rambam Medical Center, Haifa, Israel
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