Antiphospholipid antibodies and stroke

Current status and value of testing antiphospholipid antibody in patients with acute ischemic stroke: a retrospective single-center study in China

BACKGROUND AND PURPOSE

Testing for antiphospholipid antibodies (aPL) is useful to determine the cause of ischemic stroke in young and female patients. However, the clinical relevance of aPL in older patients with ischemic stroke remains unclear. We aimed to explore the status and diagnostic value of initial aPL testing in all patients with acute ischemic stroke.

METHODS

We retrospectively analyzed patients with acute ischemic stroke who were consecutively hospitalized in our hospital between June 2012 and January 2022 and investigated the factors associated with performing aPL screening in real-world clinical practice. Furthermore, factors associated with initial aPL positivity were evaluated by comparing the demographic, etiological, and therapeutic characteristics.

RESULTS

Of 1209 patients, 287 (23.7%) were tested for aPL and 58 (20.2%) tested positive. Physicians tended to conduct aPL testing on female patients (P<0.001), younger patients (P<0.001), patients with fewer vascular risk factors (P<0.001), and multiple infarctions in the multivascular blood supply area (P<0.001). Multivariate logistic regression analysis showed that only stroke of other determined etiology type was a significant influencing factor for positive aPL results (OR 2.97, 95% CI 1.137, 7.774, P=0.026), adjusting for sex, age, and causes of stroke, etc. CONCLUSION: Approximately one-quarter of the patients with acute ischemic stroke were tested for aPL. Age, sex, number of vascular risk factors, and neuroimaging features affected the discretion in performing aPL testing. aPL testing may be appropriate in older patients with no identified cause of ischemic stroke and may provide additional diagnostic opportunities for acute ischemic stroke.

Hyperhomocysteinemia Relates to the Subtype of Antiphospholipid Antibodies in Non-SLE Patients

Abnormal increases of antiphospholipid antibody and plasma homocysteine levels are recently emerging as nonlipidic risk factors for cerebral atherogenesis and thrombosis. Both antiphospholipid antibody and homocysteine share many similar bioeffects in hemostasis, but their interaction is still inconsistent. In this study, we examined the relation between the plasma homocysteine level and lupus anticoagulant, anticardiolipin antibody, and anti-β2-glycoprotein I antibody in patients with noncardiac cerebral ischemia. Systemic lupus erythrematosus patients were excluded. The results showed a higher frequency of moderate hyperhomocysteinemia in patients with an abnormal increase of lupus anticoagulant only. Neither the serum folate and cobalamin levels nor methylenetetrahydrofolate reductase allele mutation contributes to this result. Accordingly, homocysteine interacts with lupus anticoagulant to promote cerebral atherosclerosis and ischemia. The role of vasculopathic or prothrombotic autoantibody generation in response to specific pathological change such as hyperhomocysteinemia warrants further investigation.

Fulminant leucocytoclastic brainstem vasculitis in a patient with otherwise indolent systemic lupus erythematosus

The spectrum of central nervous system (CNS) vascular pathology in systemic lupus erythematosus (SLE) includes small vessel vasculopathy, thromboembolism, perivascular lymphocytic infiltration and, rarely, overt transmural vasculitis. We present the case of a patient, who experienced three CNS relapses over total disease duration of 26 years, with otherwise indolent disease. The first two relapses were suspicious of vasculitis and the last was proven at autopsy. The short duration between final relapse onset and death in this SLE CNS vasculitis case was, to our knowledge, unique. Histopathological investigation demonstrated multiple confluent areas of haemorrhage in the medulla due to an acute small vessel leucocytoclastic vasculitis.

Prevention and treatment of stroke in patients with hypertension

BACKGROUND

Each year, stroke occurs in 30.9 million individuals worldwide and is responsible for approximately 4 million deaths. In the United States, it is the third leading cause of death, occurring with greater frequency than myocardial infarction in patients with hypertension. The greatest burden of stroke, apart from death, is serious long-term physical and mental disability. Stroke survivors often experience physical handicap, depression, and cognitive dysfunction, which together affect their daily functioning, quality of life, and survival. The treatment of stroke is associated with extremely high costs, with stroke-related illnesses responsible for >$49 billion in the United States in 2002. Despite intensive research efforts, few effective treatments are available once stroke has occurred; thus, stroke prevention should be a primary focus for all health care providers.

OBJECTIVE

The purpose of this article was to review the epidemiology and burden of stroke in terms of disability, quality of life, and cost of care, and to summarize the evidence for treatments having therapeutic benefit, with an emphasis on antihypertensive agents.

METHODS

Relevant studies were identified through a MEDLINE search of English-language articles published between 1990 and 2004. The search terms were stroke, epidemiology, economic impact, disability, quality of life, hypertension, drug therapy, and angiotensin II-receptor antagonists. Articles describing major clinical studies, new data, or new mechanisms pertinent to the therapy of stroke were selected for review.

CONCLUSIONS

Identifying and modifying key risk factors is crucial to reducing the morbidity and mortality of stroke. Hypertension is one of the most important risk factors for stroke, and treatment with a variety of antihypertensive agents reduces the risk. Recent evidence suggests that the angiotensin II (ATII)-receptor antagonist losartan may offer advantages beyond blood pressure lowering, including attenuation of the central aortic reflected pressure wave, molecule-specific properties, and neural protective influences on brain ATII type 2 receptors.