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Neurologic Manifestations of Catastrophic Antiphospholipid Syndrome. Curr Neurol Neurosci Rep 2022; 22:589-600. [PMID: 36040563 DOI: 10.1007/s11910-022-01228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Understanding of antiphospholipid antibody syndrome (APS), associated neurological manifestations, and disease-directed treatment has grown considerably over the last decade. Herein, we critically review the current and high-yield literature related to the pathophysiology, neurological presentations, and management of APS with particular emphasis on the rare and more fatal subset of APS, catastrophic antiphospholipid syndrome (CAPS). RECENT FINDINGS APS may manifest with a variety of neurologic syndromes, with cerebrovascular disease representing the most commonly encountered presentation. Diagnostic evaluation and treatment are often tailored to the specific presentation, with suspicion and testing for antiphospholipid antibodies recommended when neurologic presentations occur atypically or in younger individuals. In CAPS, which is more rapidly progressive with multiorgan involvement, potential alternative microangiopathic syndromes should be carefully considered in the differential diagnosis. To date, anticoagulation with vitamin K antagonists remains the mainstay of therapy in APS while triple therapy with anticoagulation, corticosteroids, and plasma exchange is standard of care in CAPS. Immunotherapy has shown early promise in refractory cases. APS is an autoimmune clinical syndrome with neurologic presentations classically characterized by vascular thrombosis, though recent understandings suggest additional direct immune-mediated phenomena. Our understanding of the underlying pathogenic mechanisms of APS continues to grow and will continue to influence our therapeutic approaches.
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Ikenberg B, Rösler J, Seifert CL, Wunderlich S, Kaesmacher J, Zimmer C, Boeckh-Behrens T, Friedrich B, Maegerlein C. Etiology of recurrent large vessel occlusions treated with repeated thrombectomy. Interv Neuroradiol 2019; 26:195-204. [PMID: 31822162 DOI: 10.1177/1591019919892126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Repeated mechanical thrombectomy for acute stroke treatment in individual patients has been proven feasible. However, less is known about the etiology of recurrent vessel occlusions after prior thrombectomy. We aimed to understand if the etiology of such recurrent events differs from the first stroke. METHODS Retrospectively, we identified all patients at our center who received a repeated mechanical thrombectomy between 2007 and 2019. Clinical data were retrieved from medical records. Etiology of stroke was evaluated retrospectively, and angiographic studies were revisited. RESULTS Twenty-three patients (1.5%) were identified. Median age was 68 years (IQR 56-77). Median NIHSS at first admission was 11 points (IQR 5-15). In nine cases (39.1%), the recurrent vessel occlusion was located exactly at the same position as the prior occlusion. Overall, five (21.7%) patients had a remarkable extracranial pathology as likely cause of stroke recurrence. In 16 patients (69.6%), the etiology of the first stroke and its recurrence was considered as likely being the same, mostly of cardioembolic or unknown origin. In the seven remaining patients (30.4%), the cause of stroke possibly differed from the first event, with five patients (21.7%) having a postinterventional intracranial intimal lesion as possible cause of stroke. CONCLUSION Incidence of repeated thrombectomy was low. However, the high number of patients with known origin of stroke etiology raises the question how their monitoring may be optimized. The number of patients with remarkable extracranial pathologies or intracranial endothelial lesions supports current clinical practice to pay attention to final angiographic series.
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Affiliation(s)
- B Ikenberg
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - J Rösler
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - C L Seifert
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - S Wunderlich
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, TU-München, München, Germany
| | - J Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland.,Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - C Zimmer
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
| | - T Boeckh-Behrens
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
| | - B Friedrich
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
| | - C Maegerlein
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, TU-München, München, Germany
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Dai H, Liu X, Hu P, Liu J, Ming S. A Vascular Thrombus Therapy Method Based on Magnetic-Induced Vibration. Bioelectromagnetics 2019; 40:391-401. [PMID: 31236994 DOI: 10.1002/bem.22199] [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: 07/26/2018] [Accepted: 05/16/2019] [Indexed: 01/09/2023]
Abstract
A vascular thrombus therapy method based on magnetic-induced vibration is presented. It is a mechanicalway of removing vascular thrombus that adopts the combined use of two concepts, namely (i) magnetic-induced vibration of magnetostrictive materials and (ii) changes in physical form of thrombus under high-frequency impact and vibration. This method has many advantages that (i) eliminate the side effects of drug treatment, (ii) reduce the complexity of traditional mechanical method, and (iii) improve the reliability of treatment. Practical results obtained from the simulations and experiments are included. They verify the proposed system and indicate that this method can effectively treat vascular thrombus and reduce patient's suffering and costs. Bioelectromagnetics. 2019;40:391-401. © 2019 Bioelectromagnetics Society.
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Affiliation(s)
- Hongfen Dai
- First Clinical College, Hubei University of Chinese Medicine, Wuhan, P.R. China.,Department of Cardiovascular Medicine, Hubei Provincial Traditional Chinese Medical Hospital, Wuhan, P.R. China
| | - Xiaowei Liu
- School of Electrical and Automation Engineering, Wuhan University, Wuhan, P.R. China
| | - Pan Hu
- Department of Emergency, Hubei Provincial Traditional Chinese Medical Hospital, Wuhan, P.R. China
| | - Juan Liu
- Department of Emergency, Hubei Provincial Traditional Chinese Medical Hospital, Wuhan, P.R. China
| | - Shuping Ming
- First Clinical College, Hubei University of Chinese Medicine, Wuhan, P.R. China.,Department of Neurology, Hubei Provincial Traditional Chinese Medical Hospital, Wuhan, P.R. China
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Fleetwood T, Cantello R, Comi C. Antiphospholipid Syndrome and the Neurologist: From Pathogenesis to Therapy. Front Neurol 2018; 9:1001. [PMID: 30534110 PMCID: PMC6275383 DOI: 10.3389/fneur.2018.01001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022] Open
Abstract
Antiphospholipid syndrome (APS) is an autoimmune antibody-mediated condition characterized by thrombotic events and/or pregnancy morbidity in association with persistent positivity to antiphospholipid antibodies (aPL). The nervous system is frequently affected, as intracranial vessels are the most frequent site of arterial pathology. Over the course of years, many other neurological conditions not included in the diagnostic criteria, have been associated with APS. The pathogenic mechanisms behind the syndrome are complex and not fully elucidated. aPL enhance thrombosis, interfering with different pathways. Nevertheless, ischemic injury is not always sufficient to explain clinical features of the syndrome and immune-mediated damage has been advocated. This may be particularly relevant in the context of neurological complications. The reason why only a subgroup of patients develop non-criteria nervous system disorders and what determines the clinical phenotype are questions that remain open. The double nature, thrombotic and immunologic, of APS is also reflected by therapeutic strategies. In this review we summarize known neurological manifestations of APS, revisiting pathogenesis and current treatment options.
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Affiliation(s)
- Thomas Fleetwood
- Section of Neurology, Department of Translational Medicine University of Eastern Piedmont, Novara, Italy
| | - Roberto Cantello
- Section of Neurology, Department of Translational Medicine University of Eastern Piedmont, Novara, Italy
| | - Cristoforo Comi
- Section of Neurology, Department of Translational Medicine University of Eastern Piedmont, Novara, Italy.,Interdisciplinary Research Centre of Autoimmune Diseases University of Eastern Piedmont, Novara, Italy
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Chen X, Xu G. Intravenous thrombolysis in SLE-related stroke: a case report and literature review. Neurol Sci 2017; 39:155-159. [PMID: 29116545 DOI: 10.1007/s10072-017-3158-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/12/2017] [Indexed: 01/08/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) bear an increased risk of ischemic stroke. However, evidences for treating acute stroke due to artery thrombosis in SLE patients are extremely limited. A 45-year-old woman experienced sudden left hemiplegia. She was transported to the emergency department of our hospital 2 hours after the initial symptom. According to the medical records, the patient was diagnosed with SLE at the age of 28. CT scanned 150 min after the initial symptom showed no evidence of acute changes or hemorrhage. Magnetic resonance angiography (MRA) revealed occlusion of the right proximal middle cerebral artery (MCA). Ischemic stroke was diagnosed and NIHSS scored 11. The occluded MCA was successfully recanalized with intravenous rtPA. Sequent vascular imaging and serological results indicated that the etiology of the occlusion in right MCA was SLE vasculitis. The patient attained a mRS of 3 at the 3-month follow-up. The case is the first one in the literature that acute ischemic stroke related to SLE vasculitis was treated successfully with intravenous rtPA thrombolysis. The feasibility of intravenous thrombolysis for stroke related to SLE warrant further study.
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Affiliation(s)
- Xiaodong Chen
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, 210002, China. .,Department of Neurology, Shuyang People's Hospital, Shuyang, Jiangsu Province, 223600, China.
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu Province, 210002, China
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Padricelli A, Giribono AM, Ferrara D, Spalla F, Bracale U, Del Guercio L, Servillo G, Ruotolo C, Bracale UM. Severe Mesenteric Ischemia in a Pregnant Woman with Antiphospholipid Syndrome. Ann Vasc Surg 2017; 44:415.e11-415.e16. [PMID: 28483615 DOI: 10.1016/j.avsg.2017.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
Abstract
The antiphospholipid syndrome (APS), either primary or secondary form, is considered an autoimmune disease with the presence of at least 1 clinical and 1 laboratory abnormalities as defined by the Sydney criteria. Clinical criteria include vascular thrombosis of venous, artery, small vessel in any organ, and recurrent pregnancy pathologies. Mesenteric ischemia is a rare and threatening manifestation of APS. We herein report a case of a 34-year-old pregnant woman referred to our Emergency Room with thoracic and abdominal acute pain. Her past medical history was remarkable for positivity to antiphospholipid antibodies, deep vein thrombosis of the right lower limb, chronic occlusion of celiac trunk, and superior mesenteric artery and recurrent abortions. Imaging revealed acute occlusion of inferior mesenteric artery (IMA). Both a surgical and endovascular thrombectomy were ineffective to obtain durable IMA patency and so the patient underwent antegrade aorta-inferior mesenteric bypass with saphenous vein and resection of an ischemic ileal loop. The medical treatment at discharge was lifelong oral anticoagulant associated with double antiplatelet therapy. To the best of our knowledge, this is the first case reporting a young pregnant woman with APS and mesenteric ischemia submitted to several attempts of revascularization. Aggressive oral anticoagulant and antiplatelet long-term therapy is advised. Moreover, we recommend strict follow-up in those patients in order to early diagnose thrombotic recurrence.
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Affiliation(s)
- Andrea Padricelli
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Anna Maria Giribono
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Doriana Ferrara
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Flavia Spalla
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, General Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Carlo Ruotolo
- Department of Vascular Surgery, Vascular Surgery Unit, "A. Cardarelli" Hospital of Naples, Naples, Italy
| | - Umberto Marcello Bracale
- Department of Public Health, Vascular and Endovascular Surgery Unit, University Federico II of Naples, Naples, Italy.
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de Amorim LCD, Maia FM, Rodrigues CEM. Stroke in systemic lupus erythematosus and antiphospholipid syndrome: risk factors, clinical manifestations, neuroimaging, and treatment. Lupus 2017; 26:529-536. [DOI: 10.1177/0961203316688784] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Neurologic disorders are among the most common and important clinical manifestations associated with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), mainly those that affect the central nervous system (CNS). Risk of cerebrovascular events in both conditions is increased, and stroke represents one of the most severe complications, with an incidence rate between 3% and 20%, especially in the first five years of diagnosis. This article updates the data regarding the risk factors, clinical manifestations, neuroimaging, and treatment of stroke in SLE and APS.
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Affiliation(s)
| | - F M Maia
- University of Fortaleza (Unifor), Fortaleza, Brazil
| | - C E M Rodrigues
- University of Fortaleza (Unifor), Fortaleza, Brazil
- Federal University of Ceará, Fortaleza, Brazil
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