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Neurological involvement in antiphospholipid syndrome: clinical and instrumental evaluation in 21 consecutive cases
Author(s) -
Anzola G.P.,
Tincani A.,
Magoni M.,
Spatola L.,
Bonetti A.
Publication year - 1995
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.1995.tb00119.x
Subject(s) - medicine , antiphospholipid syndrome , migraine , stroke (engine) , cardiology , magnetic resonance imaging , thrombosis , embolism , abnormality , stenosis , radiology , mitral valve prolapse , mitral valve , mechanical engineering , psychiatry , engineering
Twenty‐one consecutive women with the antiphospholipid syndrome were investigated with a full cardiological and neurological examination including a semi‐structured interview. They were also systematically studied with magnetic resonance imaging (MRI), transcranial Doppler (TCD), duplex sonography of neck vessels and transesophágeal echocardiography (TEE). Nearly 67% of patients had signs or symptoms suggestive of CNS involvement Migraine‐like headache, stroke, ocular disorders and epilepsy were the most frequent disturbances. MRI was abnormal in 65% of patients who underwent the examination and showed two distinct patterns of abnormality: either territorial infarctions or multiple subcortical spotty lesions. TCD showed in one case a stenosis affecting the main trunk of the middle cerebral artery. TEE demonstrated potentially emboligenic mitral vegetations in 72% of patients. These findings suggest that antiphospholipid syndrome is burdened with a high rate of complications affecting the CNS, which are likely to be mostly thromboembolic. It is possible that both cardiogenic embolism and in situ thrombosis of cerebral vessels occur. Given the relative absence of conventional vascular risk factors, antiphospholipid antibodies are likely to represent a true risk factor for cerebrovascular disease through the mechanism of an immunologically mediated hypercoagulable state.