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Rheumatology International

, Volume 13, Issue 4, pp 169–174 | Cite as

Primary antiphospholipid antibody syndrome and cerebral ischemia: report on acute intervention in two cases and literature review with emphasis on therapeutic options

  • S. Braune
  • R. Siekmann
  • P. Waith
  • C. H. Lücking
Originals

Summary

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.

Key words

Antiphospholipid antibodies Ischemic events Intraarterial lysis Anticoagulation Immunosuppression 

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References

  1. 1.
    Antiphospholipid Antibodies in Stroke Study Group (APASS) (1992) The association of anticardiolipin antibodies with the first ischemic stroke: a multi-center case-control study. Stroke 23:161Google Scholar
  2. 2.
    Bogousslavsky J, Regli F (1987) Ischemic stroke in adults younger than 30 years of age. Arch Neurol 44:479–482Google Scholar
  3. 3.
    Brey RL, Coull BM (1992) Antiphospholipid antibodies: origin, specificity and mechanism of action. Stroke [Suppl 1] 23 (2):15–18Google Scholar
  4. 4.
    Briley DP, Coull BM, Goodnight SH (1989) Neurological disease associated with antiphospholipid antibodies. Ann Neurol 25:221–227Google Scholar
  5. 5.
    Chancellor AM, Cull RE, Kilpatrick DC, Warlow CP (1991) Neurological disease associated with anticardiolipin antibodies without systemic lupus erythematosus: clinical and immunological features. J Neurol 238:401–407Google Scholar
  6. 6.
    Levine SR, Deegan MJ, Futrell N, Welch KMA (1990) Cerebrovascular and neurologic disease associated with antiphospholipid antibodies: 48 cases. Neurology 40:1181–1189Google Scholar
  7. 7.
    Branch DW, Scott JR, Kochenour NK, Hershgold E (1985) Obstetric complications associated with the lupus anticoagulant. N Engl J Med 313:1322–1326Google Scholar
  8. 8.
    Lubbe WF, Butler WS, Palmer SJ, Liggins GC (1984) Lupus anticoagulant in pregnancy. Br J Obstet Gynaecol 91:357–363Google Scholar
  9. 9.
    Gastineau DA, Kazmier FJ, Nichols WL, Bowie EJW (1985) Lupus anticoagulant: an analysis of the clinical and laboratory features of 219 cases. Am J Haematol 19:265–275Google Scholar
  10. 10.
    Rump JA, Lang B, Engler H, Peter HH (1991) Primary antiphospholipid syndrome (PAPS). Rheumatol Int 10:255–260Google Scholar
  11. 11.
    Harris EN, Gharavi AE, Patel SP, Hughes GRV (1987) Evaluation of the anticardiolipin antibody test: report of an international workshop held 4 April 1986. Clin Exp Immunol 68:215–222Google Scholar
  12. 12.
    Brey RL, Hart RG, Sherman DG, Tegeler CH (1990) Antiphospholipid antibodies and cerebral ischemia in young people. Stroke 21:182Google Scholar
  13. 13.
    Harris EN, Gharavi AE, Hughes GR (1985) Anti-phospholipid antibodies. Clin Rheum Dis 11 (3):591–609Google Scholar
  14. 14.
    Petri M, Rheinschmidt M, Whiting-O'Keefe Q, Hellmann D, Corash L (1987) The frequency of lupus anticoagulant in systemic lupus erythematosus: a study of sixty consecutive patients by activated thromboplastin time, Russell viper venom time and anticardiolipin antibody level. Ann Intern Med 106:524–531Google Scholar
  15. 15.
    Triplett DA, Brandt JT, Maas RT (1985) The laboratory heterogeneity of lupus anticoagulant. Arch Pathol Lab Med 109:946–951Google Scholar
  16. 16.
    Levine SR, Brey RL, Joseph CLM, Havstad S, on behalf of the Antiphospholipid Antibodies in Stroke Study Group (1992) Risk of thromboembolic events in patients with focal cerebral ischemia and antiphospholipid antibodies. Stroke [Suppl 1] 23 (2):29–32Google Scholar
  17. 17.
    Antiphospholipid Antibodies in Stroke Study Group (APASS) (1990) Cooperative study of antiphospholipids/lupus anticoagulants in stroke. Stroke 21:182Google Scholar
  18. 18.
    Digre KB, Durcan EJ, Branch DW, Jacobson DM, Varner MW, Baringer JR (1989) Amaurosis fugax associated with antiphospholipid antibodies. Ann Neurol 25:228–232Google Scholar
  19. 19.
    Parke A, Maier D, Wilson D, Andreoli J, Ballow M (1989) Intravenous gamma-globulin, antiphospholipid antibodies, and pregnancy. Ann Intern Med 110:495–496Google Scholar
  20. 20.
    Scott JR, Branch DW, Kochenour NK, Ward K (1988) Intravenous immunoglobulin treatment of pregnant patients with recurrent pregnancy loss caused by antiphospholipid and Rh immunisation. Am J Obstet Gynecol 159:1055–1056Google Scholar
  21. 21.
    Wapner RJ, Cowchock FS, Shapiro SS (1989) Successful treatment in two women with antiphospholipid antibodies and refractory pregnancy losses with intravenous immunoglobulin infusions. Am J Obstet Gynaecol 161:1271–1272Google Scholar
  22. 22.
    Elder MG, De Swiet M, Robertson A, Elder MA, Floyd E, Hawkins DF (1988) Low-dose aspirin in pregnancy. Lancet I:410Google Scholar
  23. 23.
    Derksen RHWM, Hasselaar P, Blokzijl L, De Groot PG (1987) Lack of efficacy of plasma-exchange in removing antiphospholipid antibodies. Lancet II:222Google Scholar
  24. 24.
    Frampton G, Cameron JS, Thom M, Jones S, Raftery M (1987) Successful removal of anti-phospholipid antibody during pregnancy using plasma exchange and low-dose prednisolone. Lancet II:1023–1024Google Scholar
  25. 25.
    Fulcher D, Stewart G, Exner T, Trudinger B, Jeremy R (1989) Plasma exchange and the anticardiolipin syndrome in pregnancy (letter). Lancet II:171Google Scholar
  26. 26.
    Ingram SB, Goodnight SH, Bennett RM (1987) An unusual syndrome of a devastating noninflammatory vasculopathy with anticardiolipin antibodies: report of two cases. Arthritis Rheum 30 (10):1167–1172Google Scholar
  27. 27.
    Perez MC, Wilson WA, Scopelitis E (1989) Cyclophosphamide use in a young woman with antiphospholipid antibodies and recurrent cerebrovascular accidents. South Med J 82(11):1421–1424Google Scholar
  28. 28.
    Coull BM, Bourdette DN, Goodnight SH, Briley DP, Hart R (1987) Multiple cerebral infarction and dementia associated with anticardiolipin antibodies. Stroke 18(6):1107–1112Google Scholar
  29. 29.
    Hughes GRV, Harris EN, Gharavi AE (1986) The anticardiolipin syndrome. J Rheumatol 13 (3):486–489Google Scholar
  30. 30.
    Levine SR, Suhnggwon K, Deegan MJ, Welch KMA (1987) Ischemic stroke associated with anticardiolipin antibodies. Stroke 18:1101–1106Google Scholar
  31. 31.
    Harris EN (1990) A reassessment of the antiphospholipid syndrome. J Rheumatol 17 (6):733–735Google Scholar
  32. 32.
    Mackworth-Young C (1990) Antiphospholipid antibodies: more than just a disease marker? Immunol Today 11 (2):60–65Google Scholar
  33. 33.
    Landi G, Calloni MV, Sabbadini MG, Mannuccio PM, Candelise L (1983) Recurrent ischemic attacks in two young adults with lupus anticoagulant. Stroke 14(3):377–379Google Scholar
  34. 34.
    Yagnik P, Dhopesh M (1984) Stroke and circulating lupus (letter). Stroke 15(2):388–389Google Scholar
  35. 35.
    Fisher M, McGehee W (1986) Cerebral infarction, TIA and lupus inhibitor. Neurology 36:1234–1237Google Scholar
  36. 36.
    Schulze-Lohoff E, Krapf F, Bleil L, Burmester GR, Kölble K, Nüßlein HG, Rödl W, Kalden JR (1989) IGM-containing immune complexes and antiphospholipid antibodies in patients with Sneddon's syndrome. Rheumatol Int 9:43–48Google Scholar
  37. 37.
    Locht H, Lindström FD, Herder A (1991) Large vessel occlusion, cerebral infarction and thrombocytopenia in the “primary” antiphospholipid syndrome. Response to anticoagulation. Clin Exp Rheumatol 9:169–172Google Scholar
  38. 38.
    Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271–1277Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • S. Braune
    • 1
  • R. Siekmann
    • 2
  • P. Waith
    • 3
  • C. H. Lücking
    • 1
  1. 1.Neurologische Universitätsklinik FreiburgFreiburgGermany
  2. 2.Radiologische KlinikRudolf-Virchow-KrankenhausBerlinGermany
  3. 3.Abt. für RheumatologieMedizinische Universitätsklinik FreiburgFreiburgGermany

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