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VWF, Platelets and the Antiphospholipid Syndrome. Int J Mol Sci 2021; 22:ijms22084200. [PMID: 33919627 PMCID: PMC8074042 DOI: 10.3390/ijms22084200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
The antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity with the persistent presence of antiphospholipid antibodies (aPLs). Laboratory criteria for the classification of APS include the detection of lupus anticoagulant (LAC), anti-cardiolipin (aCL) antibodies and anti-β2glycoprotein I (aβ2GPI) antibodies. Clinical criteria for the classification of thrombotic APS include venous and arterial thrombosis, along with microvascular thrombosis. Several aPLs, including LAC, aβ2GPI and anti-phosphatidylserine/prothrombin antibodies (aPS/PT) have been associated with arterial thrombosis. The Von Willebrand Factor (VWF) plays an important role in arterial thrombosis by mediating platelet adhesion and aggregation. Studies have shown that aPLs antibodies present in APS patients are able to increase the risk of arterial thrombosis by upregulating the plasma levels of active VWF and by promoting platelet activation. Inflammatory reactions induced by APS may also provide a suitable condition for arterial thrombosis, mostly ischemic stroke and myocardial infarction. The presence of other cardiovascular risk factors can enhance the effect of aPLs and increase the risk for thrombosis even more. These factors should therefore be taken into account when investigating APS-related arterial thrombosis. Nevertheless, the exact mechanism by which aPLs can cause thrombosis remains to be elucidated.
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Abstract
ABSTRACT:The records of fifteen patients referred for neurological assessment and found to have lupus anticoagulant or elevated anticardiolipin antibodies were reviewed. The mean age for females in the group was 29.4 years and for males was 35. A diagnosis of migraine, either as an acute or chronic problem, was made in 10 (66%) of these patients. Seven of the 15 patients had ischemic stroke and two patients had other thrombotic complications associated with lupus anticoagulant. Three of the nine female patients with migraine had histories of spontaneous abortions. All migraine patients experienced transient or more prolonged neurological deficits with their headaches. An association between lupus anticoagulant and migraine can only be suggested. Data on the incidence of migraine in patients with lupus anticoagulant in the general medical population does not exist. Furthermore the prevalence of lupus anticoagulant in migraine sufferers is unknown. Therefore further studies are required to investigate this possible association.
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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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Abstract
Vascular parkinsonism (VP) is characterized by predominantly lower body involvement with gait impairment and postural instability, often without tremor, and by relative levodopa unresponsiveness. Neuroimaging studies demonstrate multiple infarcts or ischemic changes in periventricular white matter. Anticardiolipin antibodies (ACLA) are associated with hypercoagulable states and increased stroke risk. Review of our Movement Disorders Clinic records identified 44 individuals with a diagnosis of VP. ACLA have been obtained in 22 of these patients (mean age, 78.3 years; mean Mini-Mental Status Exam score, 25.8). Gait disturbance was the initial clinical feature in 82% of the patients, and levodopa responsiveness was present in 18% of those treated. In 9 of the 22 (40.9%), ACLA immunoglobulin G was positive. No significant differences in clinical features or risk factors (hypertension, diabetes, coronary artery disease, and clinical stroke) were evident between ACLA+ and ACLA- groups. Since the presence of ACLA in individuals with stroke is usually treated by full-scale anticoagulation with warfarin, our findings raise the question whether such treatment should also be used in persons with VP who are ACLA positive.
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Affiliation(s)
- Zhigao Huang
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
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Giorgi D, Gabrieli CB, Bonomo L. The clinico-ophthalmological spectrum of antiphospholipid syndrome. Ocul Immunol Inflamm 1998; 6:269-73. [PMID: 9924923 DOI: 10.1076/ocii.6.4.269.4025] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Antiphospholipid syndrome (APS) is a hypercoagulable disorder with highly variable symptomatology including ocular manifestations. Antiphospholipid antibodies (aPL) are the serologic markers of this clinical entity. Our aim was to note the main associated ocular features of APS and elucidate which pathogenic mechanisms may participate. Retinal vascular thrombosis and different neuro-ophthalmologic manifestations, such as optic neuropathy and amaurosis fugax, may be considered as the ocular hallmarks of this syndrome. Ocular features due to aPL-induced thrombosis should be treated with anticoagulant drugs. Conversely, for the treatment of ocular features due to immunological mechanisms such as vasculitis, immunosuppressive regimes seem to be more appropriate.
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Affiliation(s)
- D Giorgi
- Institute of Ophthalmology, La Sapienza University, School of Medicine, Rome, Italy
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Natori Y, Ikezaki K, Matsushima T, Fukui M. 'Angiographic moyamoya' its definition, classification, and therapy. Clin Neurol Neurosurg 1997; 99 Suppl 2:S168-72. [PMID: 9409430 DOI: 10.1016/s0303-8467(97)00052-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Are there any differences between probable Moyamoya disease and unilateral Moyamoya disease? What kinds of differences exist between definite and probable Moyamoya disease? Furthermore, according to the diagnostic criteria of Moyamoya disease, patients with systemic disorders and angiographic features similar to those of Moyamoya disease can not be diagnosed as Moyamoya disease. How should we call these? Such patients have been reported as 'Moyamoya syndrome,' 'quasi-Moyamoya disease', 'akin-Moyamoya disease'. etc. These variations of terminology including unilateral or probable Moyamoya disease have thus led to as state of confusion. In this study the previously reported cases in the literature were surveyed to clarify how these terms have been used and how we should use them correctly in the future. Since the diagnostic criteria of this disease are mainly based on angiographic findings, the term Moyamoya 'syndrome' should not be used. A unilateral involvement without any known cause should be called 'probable.' Because some systemic diseases commonly associated with Moyamoya disease might be genetically linked, it is better to avoid using such vague expressions as 'quasi', 'akin', or 'pseudo.' There might be a coexistence of two diseases. It is therefore better to simply state that the angiographic findings are similar to Moyamoya disease, or a systemic disease with 'angiographic Moyamoya' until the etiology of the Moyamoya disease is clarified.
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Affiliation(s)
- Y Natori
- Department of Neurosurgery, Kyushu University Faculty of Medicine, Fukuoka, Japan
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Abstract
Previous studies have reported that the prevalence of certain autoantibodies is nonspecifically elevated in elderly subjects due to immunoscenescence. This study was undertaken to assess the prevalence of anticardiolipin antibodies (aCL) in two elderly subpopulations: Two hundred and eighteen elderly were included in this study; 63 healthy elderly had a prevalence of anticardiolipin antibodies of zero; 155 unselected frail elderly were prospectively evaluated and the prevalence of anticardiolipin antibodies in this group was found to be significantly increased at 18.7%. Subdivision of this group into those elderly clinically assessed as suffering from dementia showed a prevalence of 26.5% and stroke a prevalence of 31.6%. Both were found to be statistically significantly increased when compared with both the healthy and frail elderly population. Subdivision of the dementia patients into those suffering from multi-infarct type dementia (MID) and those suffering from Alzheimer's type dementia (AD) showed an association of 44% and 20%, respectively. The association of MID with aCL was significant. This study demonstrates therefore that anticardiolipin antibodies are not nonspecifically elevated in elderly subjects but are significantly elevated in elderly subjects with strokes and multiple infarct dementia.
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Affiliation(s)
- A Juby
- Department of Medicine, University of Alberta, Edmonton, Canada
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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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Rivier G, Herranz MT, Khamashta MA, Hughes GR. Thrombosis and antiphospholipid syndrome: a preliminary assessment of three antithrombotic treatments. Lupus 1994; 3:85-90. [PMID: 7920619 DOI: 10.1177/096120339400300205] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To assess retrospectively three antithrombotic treatments in the secondary prevention of thrombosis in the antiphospholipid syndrome (APS), 23 patients (six systemic lupus erythematosus, seven lupus-like disease and 10 primary antiphospholipid syndrome) were included in this study. Treatments assessed were: (1) aspirin 75 mg daily, (2) warfarin (international normalised ratios (INRs) 2.0-2.9) +/- aspirin 75 mg daily, and (3) warfarin (INRs > 2.9) +/- aspirin 75 mg daily. Where patients had received two or three of these treatments successively, the periods of time on each treatment were added and the number of patients with recurrence(s) on each treatment were compared by Fisher's exact probability test. 'High' anticoagulation (INRs > 2.9) +/- aspirin 75 mg daily was more effective than aspirin 75 mg daily, there was a trend in favour of 'high' anticoagulation (P = 0.066). No statistically significant difference could be demonstrated when comparing 'low' anticoagulation +/- aspirin 75 mg daily with aspirin 75 mg daily (P = 0.092). These results suggest that aggressive anticoagulation with or without low-dose aspirin is effective in preventing further thromboembolic events in APS.
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Affiliation(s)
- G Rivier
- Lupus Arthritis Research Unit, Rayne Institute, St. Thomas' Hospital, London, UK
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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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Amster MS, Conway J, Zeid M, Pincus S. Cutaneous necrosis resulting from protein S deficiency and increased antiphospholipid antibody in a patient with systemic lupus erythematosus. J Am Acad Dermatol 1993; 29:853-7. [PMID: 8408826 DOI: 10.1016/0190-9622(93)70254-q] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 23-year-old woman with widespread cutaneous necrosis resulting from protein S deficiency and increased antiphospholipid antibody in the setting of systemic lupus erythematosus is described. Our report illustrates the complex nature of evaluation of skin lesions in patients with active systemic lupus erythematosus.
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Affiliation(s)
- M S Amster
- Department of Dermatology, State University of New York at Buffalo
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Mesa HA, Lang B, Schumacher M, Vaith P, Peter HH. Sneddon's syndrome and phospholipid antibodies. Clin Rheumatol 1993; 12:253-6. [PMID: 8358989 DOI: 10.1007/bf02231537] [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: 01/30/2023]
Abstract
We present a case of Sneddon's syndrome with high titers of antiphospholipid antibodies (APLA), in which the leading symptom was an incapacitating memory defect. MRI revealed vasculitic lesions of the central nervous system (CNS). Therefore immunosuppressive therapy was started with steroids and cyclophosphamide pulses. The transient beneficial effects of such a therapy will be discussed.
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Affiliation(s)
- H A Mesa
- Department of Rheumatology and Clinical Immunology, University of Freiburg Medical Center, Freiburg, Germany
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Czlonkowska A, Meurer M, Palasik W, Baranska-Gieruszczak M, Mendel T, Wierzchowska E. Anticardiolipin antibodies, a disease marker for ischemic cerebrovascular events in a younger patient population? Acta Neurol Scand 1992; 86:304-7. [PMID: 1414251 DOI: 10.1111/j.1600-0404.1992.tb05090.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The prevalence of anticardiolipin antibodies (ACLA) in sera of 49 patients having had their first TIA or ischemic stroke before 50 years of age was studied using a solid phase enzyme immunosorbent assay (ELISA). Five patients had IgM antibodies, eight had IgG, and three had antibodies belonging to both classes. Although ACLA were detected in 32% of patients (95% confidence interval [CI] 19-45%), the ACLA positive group did not differ with respect to clinical characteristics and distribution of major stroke risk factor frequency from the ACLA negative group. Further investigations are needed to establish the role of ACLA in the pathogenesis of ischemic cerebrovascular diseases.
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Affiliation(s)
- A Czlonkowska
- Institute of Psychiatry and Neurology, Warsaw, Poland
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Vascular disease in the antiphospholipid syndrome: A comparison with the patient population with atherosclerosis. J Vasc Surg 1992. [DOI: 10.1016/0741-5214(92)70024-f] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rump JA, Lang B, Engler H, Peter HH. Primary antiphospholipid syndrome (PAPS). Two case reports and therapeutic implications. Rheumatol Int 1991; 10:255-60. [PMID: 2041985 DOI: 10.1007/bf02274889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Antiphospholipid antibodies (aPL) interfere with the coagulation system and can cause thrombosis and other clotting disorders. The combination of recurrent venous thrombosis, arterial embolism and recurrent fetal loss is nowadays considered to be primary antiphospholipid syndrome (PAPS), provided an underlying systemic lupus erythematosus (SLE) has been excluded and aPL have been detected. We report on two patients with PAPs, and show the course of their IgG- and IgM-anticardiolipin antibody (aCL) titers during immunosuppressive therapy with prednisone and azathioprine or cyclophosphamide. Over a period of 18 months this therapy was effective in preventing relapses of thrombo-embolism and other complications. Therapy with cyclophosphamide resulted in normalization of the aCL titers in one of the two reported cases. Azathioprine treatment reduced the aCL titer in the other patient, without fully normalizing it. Based on our observation, we propose to treat PAPS-associated severe and recurrent thrombo-embolic complications by aggressive immunosuppression, including azathioprine and cyclophosphamide.
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Affiliation(s)
- J A Rump
- Department of Rheumatology and Clinical Immunology, University of Freiburg, Federal Republic of Germany
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Wiener HM, Vardinon N, Yust I. Platelet antibody binding and spontaneous aggregation in 21 lupus anticoagulant patients. Vox Sang 1991; 61:111-21. [PMID: 1763496 DOI: 10.1111/j.1423-0410.1991.tb00256.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In order to ascertain the role of the antiphospholipid antibody in the pathogenesis of thrombotic disorders, a study of 21 lupus anticoagulant-positive patients was done by a number of serologic and functional platelet tests. In immunofluorescent studies, we found that 80% showed a mitochondrial pattern on HEp cells and all patients gave an ubiquitously intense staining of donor platelets. By a microscopic spontaneous aggregation test, all lupus anticoagulant-positive patients showed accelerated platelet aggregation which was calcium-independent. The results show that the plasma of lupus anticoagulant-positive patients contains a platelet-binding antibody and causes spontaneous agglutination of platelets. These properties may play a role in the thrombogenesis common to the antiphospholipid syndrome.
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Affiliation(s)
- H M Wiener
- Department of Medicine A, Tel Aviv Medical Center, Israel
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Michielsens B, Walravens M, Vermylen J, Carton H. Diagnostic significance of antinuclear antibodies in neurologic patients. Acta Neurol Scand 1991; 84:102-6. [PMID: 1950446 DOI: 10.1111/j.1600-0404.1991.tb04916.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a combined retrospective and prospective study, we tried to define the prevalence of antinuclear antibodies (ANA) and its clinical relevance in neurological patients. Three hundred twenty-seven neurological patients who had ANA determined because of suspicion of connective tissue disease (CTD), were retrospectively studied. Thirty (9.2%) were ANA positive, 20 (66%) of whom had CTD. Of 327 consecutively admitted patients, prospectively studied, 18 (5.5%) were ANA positive, 5 (28%) of whom had evidence of CTD. Systemic lupus erythematosus (SLE) was the most frequently diagnosed CTD. In a prospective study of 48 multiple sclerosis (MS) patients, only 1 had detectable ANA at a dilution of 1:40. Lupus anticoagulant (LA) was prospectively detected in 2 patients but was not associated with a vascular or autoimmune systemic disease.
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Affiliation(s)
- B Michielsens
- Department of Neurology, University Hospital, Leuven, Belgium
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Montalbán J, Codina A, Ordi J, Vilardell M, Khamashta MA, Hughes GR. Antiphospholipid antibodies in cerebral ischemia. Stroke 1991; 22:750-3. [PMID: 2057974 DOI: 10.1161/01.str.22.6.750] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- J Montalbán
- Servei de Neurologia, Hospital General Vall d'Hebron, Barcelona, Spain
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Abstract
Antiphospholipid antibodies have occasionally been observed in small series of migraine patients, possibly signalling an immunological pathogenesis in a subgroup. We have measured anticardiolipin antibody levels in a series of 94 migraine patients (35 patients having migraine with aura, 59 without aura), during acute attacks and between attacks. Platelet counts were normal and VDRL was negative in all patients. A low positive anticardiolipin antibody level was found in only one patient, which was negative six months later. There appears to be no association between the presence of anticardiolipin antibodies and migraine. Antiphospholipid antibodies are unlikely to have a material pathogenetic role. Statistically, the incidence of significantly raised anticardiolipin antibody levels in this group of patients does not exceed 4% at a 95% probability level.
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Affiliation(s)
- R Hering
- Princess Margaret Migraine Clinic, Charing Cross and Westminster Medical School, London, UK
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Prevention of recurrent stroke in patients with systemic lupus erythematosus or lupus anticoagulant. J Stroke Cerebrovasc Dis 1991; 1:9-20. [DOI: 10.1016/s1052-3057(11)80015-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Weller M, Leo-kottler B, Berg PA, Wietholter H. Effective suppression of crescendo amaurosis fugax associated with anti-phospholipid antibodies by low dose aspirin. Neuroophthalmology 1991. [DOI: 10.3109/01658109109036956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
In recent years an association has been described between, on the one hand, an in vitro prolongation of phospholipid-dependent coagulation tests (the 'lupus anticoagulant') or the demonstration of antiphospholipid antibodies and, on the other, clinical events, particularly recurrent thrombosis (usually venous but sometimes arterial), thrombocytopenia, and also recurrent mid-term fetal loss. Other less well-documented associations with haemolytic anaemia, livedo reticularis, strokes and other neurological syndromes have been suggested. The antibodies are present temporarily in many infections, are usually of IgM isotype and thrombosis does not occur. However, they are persistently present and mainly of IgG isotype in a number of auto-immune disorders associated with thrombosis, in particular systemic lupus erythematosus, in which 50% of patients will show antibody of one isotype or another. The strongest association is with antinuclear factor-negative lupus and 'lupus-like' disorders in which a full diagnosis of classical lupus cannot be made. The clotting test abnormality and antiphospholipid antibodies may be found also in otherwise normal individuals suffering thrombosis or fetal loss--the so-called primary antiphospholipid syndrome. These data raise important questions for management, but many details are controversial despite a decade's work; this review examines the present position and outlines some of the difficulties, particularly from the point of view of nephrology and paediatrics.
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Affiliation(s)
- J S Cameron
- Renal Unit, Clinical Science Laboratories, Guy's Hospital, London, UK
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Sammaritano LR, Gharavi AE, Lockshin MD. Antiphospholipid antibody syndrome: immunologic and clinical aspects. Semin Arthritis Rheum 1990; 20:81-96. [PMID: 2251509 DOI: 10.1016/0049-0172(90)90021-7] [Citation(s) in RCA: 161] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Antiphospholipid antibody is associated with a clinical syndrome of vascular thrombosis, thrombocytopenia, recurrent fetal loss, and livedo reticularis, whether or not a clinical diagnosis of systemic lupus erythematosus (SLE) coexists. A positive antiphospholipid antibody test is defined by enzyme-linked immunosorbent assay (ELISA) (antiphospholipid antibody itself) or by coagulation assay (lupus anticoagulant). These are similar but not identical antibodies. The test for syphilis is less closely related to the preceding two and is less regularly associated with clinical complications. The mechanism of action of either antiphospholipid antibody or lupus anticoagulant is as yet unknown. SLE-induced but not infection-induced antiphospholipid antibody has immunoglobulin G2 (IgG2) and IgG4 predominance. It recognizes all negatively charged phospholipids, but various physical characteristics of the phospholipids alter the recognition patterns. Treatment for the antiphospholipid antibody syndrome has not been clearly defined. Anticoagulation with aspirin, heparin, or warfarin is currently favored. A role for corticosteroid remains to be demonstrated.
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Affiliation(s)
- L R Sammaritano
- Division of Rheumatic Diseases, Hospital for Special Surgery, Cornell University Medical Center, New York, NY
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Abstract
More than a dozen primary hematologic disorders have been associated with ischemic stroke. Inherited deficiencies of antithrombin III, protein C, and protein S have been linked with stroke in case reports; optimal screening requires functional as well as antigenic assays. Antiphospholipid antibodies and lupus anticoagulants are the most frequently identified acquired states associated with ischemic stroke. Polycythemia vera, sickle cell anemia, sickle-C disease, and essential thrombocythemia are the major disorders of formed blood elements causing stroke. Special, step-wise screening for occult prothrombotic entities in stroke patients is recommended for young persons with stroke of uncertain cause, for those with prior venous thrombosis, for those with a family history of unusual thrombosis, and for those with no other explanation for recurrent stroke. Acquired, perhaps transient, abnormalities of platelets, coagulation inhibition, and fibrinolysis may contribute importantly to brain ischemia in synergy with other mechanisms, but at present these remain ill-defined. The contribution of prothrombotic diatheses to stroke is probably underrecognized and warrants further investigation.
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Affiliation(s)
- R G Hart
- Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284
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Alegre VA, Winkelmann RK, Gastineau DA. Cutaneous thrombosis, cerebrovascular thrombosis, and lupus anticoagulant--the Sneddon syndrome. Report of 10 cases. Int J Dermatol 1990; 29:45-9. [PMID: 2109736 DOI: 10.1111/j.1365-4362.1990.tb03755.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Ten patients with circulating lupus anticoagulant who presented with cutaneous vascular disease and cerebrovascular disease are presented. Cutaneous manifestations were gangrene, thrombophlebitis, ulcers, and livedo reticularis. All 10 patients had cerebral infarction. The relationship between the cerebral and cutaneous vascular changes and the presence of lupus anticoagulant is supported by a common noninflammatory vascular thrombosis histologically in these patients and by the presence of similar pathologic and clinical findings in patients with the lupus anticoagulant syndrome.
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Affiliation(s)
- V A Alegre
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905
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Bruno A, Corbett JJ, Biller J, Adams HP, Qualls C. Transient monocular visual loss patterns and associated vascular abnormalities. Stroke 1990; 21:34-9. [PMID: 2300989 DOI: 10.1161/01.str.21.1.34] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To determine if certain transient monocular visual loss patterns predict the associated vascular abnormalities, we prospectively evaluated 100 consecutive patients. Each patient had hematologic tests, a carotid artery study (arteriography in 74, duplex ultrasonography in the remaining 26), and an ophthalmologic examination. Patients with altitudinal or lateralized transient monocular visual loss were more likely to have carotid artery stenosis, carotid artery ulceration, cardiac sources of emboli, or visible retinal emboli than patients with other visual loss patterns. Our findings suggest that altitudinal or lateralized transient monocular visual loss is primarily caused by embolism but that other visual loss patterns are usually caused by nonembolic mechanisms.
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Affiliation(s)
- A Bruno
- Neurology Service, Veterans Administration Medical Center, Albuquerque, NM 87108
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29
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Maaravi Y, Raz E, Gilon D, Rubinow A. Cerebrovascular accident and myocardial infarction associated with anticardiolipin antibodies in a young woman with systemic lupus erythematosus. Ann Rheum Dis 1989; 48:853-5. [PMID: 2637695 PMCID: PMC1003894 DOI: 10.1136/ard.48.10.853] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A 26 year old woman with systemic lupus erythematosus, including malar rash, photosensitivity, and arthritis, developed a cerebrovascular accident and acute myocardial infarction. High titres to antinuclear factor, anti-DNA antibodies, positive Venereal Disease Research Laboratory (VDRL) test, and anticardiolipin antibodies were found in her serum. A possible association between the presence of anticardiolipin antibodies and the two major thrombotic events is discussed.
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Affiliation(s)
- Y Maaravi
- Department of Medicine, Mount Scopus, Hadassah University Hospital, Jerusalem, Israel
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30
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Young SM, Fisher M, Sigsbee A, Errichetti A. Cardiogenic brain embolism and lupus anticoagulant. Ann Neurol 1989; 26:390-2. [PMID: 2508537 DOI: 10.1002/ana.410260313] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- S M Young
- Department of Neurology, Worcester Memorial Hospital, MA 01605
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31
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Kleiner RC, Najarian LV, Schatten S, Jabs DA, Patz A, Kaplan HJ. Vaso-occlusive retinopathy associated with antiphospholipid antibodies (lupus anticoagulant retinopathy). Ophthalmology 1989; 96:896-904. [PMID: 2472589 DOI: 10.1016/s0161-6420(89)32825-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors observed three cases (6 eyes) of vaso-occlusive retinopathy associated with the lupus anticoagulant and the related antiphospholipid antibody anticardiolipin. The disease occurred in patients who had no definable autoimmune disease such as systemic lupus erythematosus (SLE) and was characterized by severe bilateral retinal vascular occlusion. There was profound visual loss from intraretinal ischemia as well as vitreous hemorrhage from preretinal neovascularization. Results of laboratory testing showed a prolonged partial thromboplastin time (PTT) in two patients, and the presence of the lupus anticoagulant in all. Treatment with panretinal photocoagulation appeared to stabilize the neovascularization. The role of systemic anticoagulation and immunosuppressive therapy is uncertain.
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Affiliation(s)
- R C Kleiner
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
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32
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Liu HW, Wong KL, Lin CK, Wong WS, Tse PW, Chan GT. The reappraisal of dilute tissue thromboplastin inhibition test in the diagnosis of lupus anticoagulant. Br J Haematol 1989; 72:229-34. [PMID: 2503025 DOI: 10.1111/j.1365-2141.1989.tb07687.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The dilute tissue thromboplastin inhibition (DTTI) test (Schleider et al, 1976) is a sensitive but non-specific test for lupus anticoagulant (LA). False positive results are seen in patients with clotting factor deficiency involving the extrinsic pathway and also in some patients with specific factor inhibitors (Triplett et al, 1983; Rosove et al, 1986). Since the effect of LA is phospholipid dependent but those of factor deficiency and specific inhibitors are not, we analyse the test results by comparing the degree of inhibition using different dilutions of tissue thromboplastin and express it as the DTTI index. This is defined as the clotting time ratio with 0.2% tissue thromboplastin divided by the clotting time ratio with 2% tissue thromboplastin. We also perform a dilute tissue thromboplastin time with platelet substitution to see if this could neutralize the inhibition caused by LA. Both of these modifications can reliably distinguish LA from other conditions associated with prolonged APTT better than the original DTTI test.
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Affiliation(s)
- H W Liu
- Department of Pathology, Queen Mary Hospital, University of Hong Kong
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33
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Futrell N, Millikan C. Frequency, etiology, and prevention of stroke in patients with systemic lupus erythematosus. Stroke 1989; 20:583-91. [PMID: 2718197 DOI: 10.1161/01.str.20.5.583] [Citation(s) in RCA: 146] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We retrospectively and prospectively reviewed the incidence of stroke in 105 patients with systemic lupus erythematosus (SLE). Stroke occurred in 14 (15%) of 91 consecutive patients with documented SLE; nine (64%) of the 14 had multiple cerebral infarcts. Factors associated with stroke and the frequency of stroke were systemic thrombosis (30%), elevated partial thromboplastin time (36%), spontaneous abortion (50%), age over 60 years (57%), transient ischemic attacks (57%), previous stroke (64%), and cardiac valvular disease (86%). The major period of risk for the first stroke was during the first 5 years of SLE. The most frequent etiology was a cardiogenic embolus or an antibody-mediated hypercoagulable state, with cerebral vasculitis occurring only in association with infection. Because of the decreased fibrinolysis seen in patients with SLE, anticoagulant therapy may be the most effective preventive treatment currently available. Anticoagulant therapy seemed to prevent recurrent focal cerebral ischemia in our patients and was associated with relatively few and minor complications. Patients with a history of transient ischemic attacks or cardiac valvular lesions are at high (57% and 87%, respectively) risk of stroke. Patients who have had a stroke are at high (64%) risk for a recurrent stroke. Anticoagulant therapy is recommended for all of these patients.
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Affiliation(s)
- N Futrell
- Department of Neurology, University of Miami, Florida
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34
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Chancellor AM, Glasgow GL, Ockelford PA, Johns A, Smith J. Etiology, prognosis, and hemostatic function after cerebral infarction in young adults. Stroke 1989; 20:477-82. [PMID: 2494781 DOI: 10.1161/01.str.20.4.477] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We retrospectively evaluated 66 patients younger than 40 years of age who presented with acute nonhemorrhagic cerebral infarction (n = 63) or transient ischemic attacks (n = 3) to determine the possible etiology and long-term outcome at a mean follow-up interval of 3 years after initial presentation. A probable cause for the stroke was identified in 24 patients (36%); this group included one woman with a history of recurrent spontaneous abortions and a positive test for the presence of the lupus anticoagulant. We performed detailed hemostatic investigations at follow-up in 38 (90%) of the remaining 42 patients in whom the cause of the stroke was unknown or uncertain; results of the basic hemostatic screening tests (including that for fibrinogen) were uniformly normal. All 38 patients demonstrated a normal fibrinolytic response as measured by tissue plasminogen activator release to a standard venous occlusion stress test; concentration of the inhibitor of tissue plasminogen activator was not increased. No abnormalities in the concentrations of the inhibitory proteins C or S or antithrombin III were identified, and none of the 38 patients had evidence of a lupus anticoagulant. Neurologic recovery was complete or the residual disability mild in 46 of 59 (78%) patients. Overall prognosis was excellent and independent of whether a precipitating factor for the stroke could be identified.
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Affiliation(s)
- A M Chancellor
- Departments of Neurology, Auckland Hospital, New Zealand
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35
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Asherson RA, Khamashta MA, Gil A, Vazquez JJ, Chan O, Baguley E, Hughes GR. Cerebrovascular disease and antiphospholipid antibodies in systemic lupus erythematosus, lupus-like disease, and the primary antiphospholipid syndrome. Am J Med 1989; 86:391-9. [PMID: 2494884 DOI: 10.1016/0002-9343(89)90335-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE AND PATIENTS AND METHODS Antiphospholipid antibodies, lupus anticoagulant antibodies to cardiolipin, and a false-positive result on testing for syphilis have been linked to thrombotic vascular occlusions, particularly in patients with systemic lupus erythematosus (SLE) or lupus-like disease, i.e., patients not fulfilling four American Rheumatism Association criteria for the classification of SLE. The clinical and serologic features of 35 patients with cerebrovascular disease (strokes/transient ischemic attacks) who demonstrated antibodies to phospholipids are presented. Complete histories were obtained from all 35 patients, and all underwent routine physical examinations, radiography, electrocardiography, computed tomographic brain scanning, and immunologic studies. Psychometric tests were performed in nine patients. RESULTS The strokes were often multiple and were followed by multi-infarct dementia in nine patients. Of particular interest were 10 patients in whom the presence of antiphospholipid antibodies was the major and often the sole immunologic disturbance present. Several of these patients were antinuclear antibody-negative, and the antinuclear antibodies, when present, were usually of a low titer (1:40 to 1:160). These patients conform to a group classified as having a primary antiphospholipid syndrome. CONCLUSION Antiphospholipid antibodies are strongly associated with cerebrovascular occlusions in patients with SLE as well as in those with lupus-like disease and the primary antiphospholipid syndrome. All patients with any of these conditions who present with vascular events should be screened for these antibodies, as their occurrence may have a bearing on future therapy.
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Affiliation(s)
- R A Asherson
- Lupus Arthritis Research Unit, Rayne Institute, London, England
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36
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Abstract
This retrospective study of 295 patients extends the earlier findings of an association between lupus anticoagulation and thrombosis by demonstrating the occurrence of cutaneous lesions related to the coagulation defect in 70 patients. The most frequent cutaneous associations were thrombophlebitis, skin ulcer, gangrene, haemorrhage, and cutaneous necrosis. Of the patients with skin lesions, 41% had the skin lesion as the first sign of the disease. It is important to recognize this association because nearly 40% of the patients with skin lesions have multisystem thrombotic phenomena in the course of the disease.
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Affiliation(s)
- V A Alegre
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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37
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Digre KB, Durcan FJ, Branch DW, Jacobson DM, Varner MW, Baringer JR. Amaurosis fugax associated with antiphospholipid antibodies. Ann Neurol 1989; 25:228-32. [PMID: 2729913 DOI: 10.1002/ana.410250304] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In more than 50% of amaurosis fugax patients under 45 years of age no cause for the episodes of visual loss is identifiable. We have encountered 6 young adults (4 women and 2 men) with episodes of amaurosis fugax associated with elevated levels of antiphospholipid antibodies. Splinter hemorrhages of the nail beds were present in most patients. Treatment with antiplatelet medications and anticoagulants appeared to reduce the frequency of episodes and might prevent central retinal artery occlusions or stroke.
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Affiliation(s)
- K B Digre
- Department of Neurology, University of Utah Medical Center, Salt Lake City 84132
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38
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Abstract
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.
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Affiliation(s)
- M Kushner
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 19104
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39
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Abstract
Lupus anticoagulant was found in the plasma of 4 patients who presented with late-onset epileptic seizures. Three of the patients had clinical or electroencephalographic evidence of focality. No significant cerebral pathological findings were detected by the computed tomogram except for an old infarction in one case. None of the patients fulfilled the diagnostic criteria for systemic lupus erythematosus. The relationship between late-onset seizures and the presence of lupus anticoagulant is discussed. The possible etiology of an ischemic episode due to hypercoagulability, expressed uniquely by seizures, is suggested.
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Affiliation(s)
- R Inzelberg
- Department of Neurology, Tel-Aviv Medical Center, Tel-Aviv University, Israel
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40
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Mills TJ, Safford RE, Kazmier FJ. Myocardial infarction, persistent coronary artery thrombosis and lupus anticoagulant. Int J Cardiol 1988; 21:190-4. [PMID: 3147243 DOI: 10.1016/0167-5273(88)90224-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 40-year-old man who presented with exertional angina had had two myocardial infarctions within the same myocardial distribution several years earlier. Coronary arteriography revealed a large intramural thrombus in the right coronary artery and minimal atherosclerotic disease. Special coagulation studies detected a circulating lupus anticoagulant. The association of repeated episodes of thrombosis and lupus anticoagulant is important. In patients with repeated thrombotic events, the lupus anticoagulant should be sought, particularly in those less than 40 years of age.
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Affiliation(s)
- T J Mills
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
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41
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Barbui T, Cortelazzo S, Galli M, Parazzini F, Radici E, Rossi E, Finazzi G. Antiphospholipid antibodies in early repeated abortions: a case-controlled study**This study was conducted in the framework of the Lombardy Region Health Projects contract 473, and of the CNR (Italian National Research Council) applied projects, “Preventive and Rehabilitative Medicine” contracts 85.00487.56 and 85.00549.56. Fertil Steril 1988. [DOI: 10.1016/s0015-0282(16)60188-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Levine SR, Crofts JW, Lesser GR, Floberg J, Welch KM. Visual symptoms associated with the presence of a lupus anticoagulant. Ophthalmology 1988; 95:686-92. [PMID: 3140158 DOI: 10.1016/s0161-6420(88)33139-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The lupus anticoagulant is an acquired serum immunoglobulin that prolongs several coagulation parameters, most notably the partial thromboplastin time (PTT). Most commonly, this condition is found in association with systemic lupus erythematosus (SLE) but may be seen with other collagen-vascular diseases and in otherwise healthy individuals. Despite the laboratory tests suggesting impaired coagulation, clinically the lupus anticoagulant has been associated with thrombosis. The authors present five patients with the lupus anticoagulant who came to medical attention because of branch retinal artery occlusion, ischemic optic neuropathy, transient visual loss, transient diplopia, or vertebrobasilar insufficiency. Eleven previously reported patients with the lupus anticoagulant and disturbed vision are also reviewed with additional findings of retinal venous occlusive disease and homonymous visual field loss. The relationship of these findings to retinopathy in SLE is discussed. Patients with the lupus anticoagulant (with or without SLE) may develop disturbances in vision due to thrombosis from a hypercoagulable state. We recommended obtaining a PTT, VDRL, and the more sensitive anticardiolipin antibody in patients with unexplained visual symptoms.
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Affiliation(s)
- S R Levine
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202
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43
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44
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Merry P, Acheson JF, Asherson RA, Hughes GR. Management of retinal vein occlusion. BRITISH MEDICAL JOURNAL (CLINICAL RESEARCH ED.) 1988; 296:294. [PMID: 3124926 PMCID: PMC2544798 DOI: 10.1136/bmj.296.6617.294] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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45
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Hart LL. Sequential hormonochemotherapy in advanced breast cancer. BMJ : BRITISH MEDICAL JOURNAL 1988; 296:293-4. [PMID: 3124925 PMCID: PMC2544809 DOI: 10.1136/bmj.296.6617.293-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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46
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el-Mallakh RS, Donaldson JO, Kranzler HR, Racy A. Phenothiazine-associated lupus anticoagulant and thrombotic disease. PSYCHOSOMATICS 1988; 29:109-13. [PMID: 3124190 DOI: 10.1016/s0033-3182(88)72430-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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Pellegrino TR. Vascular Syndromes. Emerg Med Clin North Am 1987. [DOI: 10.1016/s0733-8627(21)00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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48
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Asherson RA, Mercey D, Phillips G, Sheehan N, Gharavi AE, Harris EN, Hughes GR. Recurrent stroke and multi-infarct dementia in systemic lupus erythematosus: association with antiphospholipid antibodies. Ann Rheum Dis 1987; 46:605-11. [PMID: 3116954 PMCID: PMC1002208 DOI: 10.1136/ard.46.8.605] [Citation(s) in RCA: 136] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Four patients with recurrent stroke and multi-infarct dementia are presented in whom the dementia was progressive and severe. Three of the patients developed the dementia during the course of an illness which was punctuated by repeated episodes of cerebral infarction demonstrated by computed tomographic (CT) scans. The fourth patient presented with an illness dominated by progressive and deteriorating higher mental functions, which culminated in a major stroke 18 months later. Three patients fulfilled the American Rheumatism Association (ARA) criteria for the classification of systemic lupus erythematosus, the fourth had a 'lupus-like' disease. All had livedo reticularis, severe migraines, and also demonstrated antibodies to phospholipids. All four patients suffered deep vein thromboses.
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Affiliation(s)
- R A Asherson
- Lupus Arthritis Research Unit, Rayne Institute, St Thomas's Hospital, London
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49
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Levine SR, Kieran S, Puzio K, Feit H, Patel SC, Welch KM. Cerebral venous thrombosis with lupus anticoagulants. Report of two cases. Stroke 1987; 18:801-4. [PMID: 3111017 DOI: 10.1161/01.str.18.4.801] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Lupus anticoagulants are circulating autoantibodies, primarily directed against phospholipids, that prolong the partial thromboplastin time. They have been previously associated with systemic arterial and venous thrombosis and arterial stroke, but not with cerebral venous thrombosis. We describe 2 young patients with cerebral venous thrombosis documented by intravenous digital subtraction angiography in whom a lupus anticoagulant was demonstrated. Both patients improved with corticosteroid and anticoagulant therapy.
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50
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Levine SR, Joseph R, D'Andrea G, Welch KM. Migraine and the lupus anticoagulant. Case reports and review of the literature. Cephalalgia 1987; 7:93-9. [PMID: 3111715 DOI: 10.1046/j.1468-2982.1987.0702093.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Lupus anticoagulants (LA) are antiphospholipid serum immunoglobulins generally associated with autoimmune conditions, especially systemic lupus erythematosus (SLE). They have recently been linked to thrombotic events, including stroke. A possible association of migraine with LA is now forwarded with the presentation of two cases and a literature review. Our two patients, both in their forties, had migrainous phenomena without SLE or thrombotic events. Eight other cases were found in the literature, suggesting more than a chance association. Relevance to migraine pathophysiology is discussed and may come from the ability of the LA to alter prostaglandins and platelet activity and to interact with neuronal phospholipids. Further, larger studies are needed to support this association.
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