Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Primary Antiphospholipid Antibody Syndrome: Neuroradiologic Findings in 11 Patients

  • Jung Hoon Kim (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choong-Gon Choi (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Soo-Jung Choi (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ho Kyu Lee (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dae Chul Suh (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 1999.10.13
  • Accepted : 2000.02.09
  • Published : 2000.03.31
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Abstract

Objective: To describe the neuroradiologic findings of primary antiphospholipid antibody syndrome (PAPS). Materials and Methods: During a recent two-year period, abnormally elevated antiphospholipid antibodies were detected in a total of 751 patients. In any cases in which risk factors for stroke were detected - hypertension, diabetes mellitus, hyperlipidemia, smoking, and the presence of SLE or other connective tissue diseases - PAPS was not diagnosed. Neuroradiologic studies were performed in 11 of 32 patients with PAPS. We retrospectively reviewed brain CT (n = 7), MR (n = 8), and cerebral angiography (n = 8) in 11 patients with special attention to the presence of brain parenchymal lesions and cerebral arterial or venous abnormalities. Results: CT or MR findings of PAPS included nonspecific multiple hyper-intensity foci in deep white matter on T2-weighted images (5/11), a large infarct in the territory of the middle cerebral artery (4/11), diffuse cortical atrophy (2/11), focal hemorrhage (2/11), and dural sinus thrombosis (1/11). Angiographic findings were normal (5/8) or reflected either occlusion of a large cerebral artery (2/8) or dural sinus thrombosis (1/8). Conclusion: Neuroradiologic findings of PAPS are nonspecific but in young or middle- aged adults who show the above mentioned CT or MR findings, and in whom risk factors for stroke are not present, the condition should be suspected.

Keywords

References

  1. Harris EN, Gharavi AE, Hughes GRV. Antiphospholipid antibodies. Clin Rheum Dis 1985;11:591-609  https://doi.org/10.1016/S0307-742X(21)00606-8
  2. Harris EN, Baguley E, Asherson RA, et al. Clinical and serological features of the antiphospholipid syndrome . Br J Rheumatol 1987;26(S):19 
  3. Hughson MD, Mccarty GA, Brumback RA. Spectrum of vascular pathology affecting patients with the antiphospholipid syndrome. Hum Pathol 1995;26:716-724  https://doi.org/10.1016/0046-8177(95)90218-X
  4. Asherson RA, Khamashta MA, Ordi-Ros J, et al. The primary antiphospholiupid syndrome: major clinical and serological features. Medicine 1989;68:366-374  https://doi.org/10.1097/00005792-198911000-00004
  5. Gharavi AE, Wilson WA. The syndrome of thrombosis, thrombocytopenia, and recurrent spontaneous abortions associated with antiphospholipid antibodies: Hughes syndrome. Lupus 1996;5:343-344  https://doi.org/10.1177/096120339600500501
  6. Provenzale JM, Heinz ER, Ortel TL, et al. Antiphospholipid antibodies in patients without SLE: neuroradiologic findings. Radiology 1994;192:531-537  https://doi.org/10.1148/radiology.192.2.8029427
  7. Provenzale JM, Barboriak DP, Allen NB, Ortel TL. Patients with antiphospholipd antibodies: CT and MR findings of the brain. AJR 1996;167:1573-1578  https://doi.org/10.2214/ajr.167.6.8956600
  8. Toubi E, Khamashta MA, Panarra A, Hugham GRV. Association of antiphospholipid antibodies with central nervous system disease in SLE. Am J Med 1995;99:397-401  https://doi.org/10.1016/S0002-9343(99)80188-0
  9. Brey RL, Gharavi AE, Lockshin MD. Neurologic complications of antiphospholipid antibodies. Rheumatol Clin North Am 1993;4:833-850  https://doi.org/10.1016/S0889-857X(21)00209-X
  10. Oeffinger KC, Roaten SP. Antihpospholipid syndrome. J Fam Prac 1994;38:611-619 
  11. Petri M. Pathogenesis and treatment of the antiphospholipid antibody syndrome. Med Clin North Am 1997;81:151-177  https://doi.org/10.1016/S0025-7125(05)70509-5
  12. Aron AL, Gharavi AE, Shoenfeld Y. Mechanisms of action of antiphospholipid antibodies in the antiphospholipid antibodies in the antiphospholipd syndrome. Int Arch Allergy Immunol 1995;106:8-12  https://doi.org/10.1159/000236883
  13. Lechner K, Pabinger-Fasching I. Lupus anticoagulants and thrombosis: a study of 25 cases and review of the literature. Haemostasis 1985;15:254-262  https://doi.org/10.1159/000215157
  14. Levine SR, Brey RL. Neurological aspects of antihpospholipid antibody syndrome. Lupus 1996;5:347-353  https://doi.org/10.1177/096120339600500503
  15. Westerman EM, Miles JM. Neuropathologic findings in multi-infarct dementia associated with anticardiolipin antibody. Arthritis Rheum 1992;35:1038-1041  https://doi.org/10.1002/art.1780350908
  16. Coull BM, Bourdette DN, Goodnight SH, Briley DP, Hart R. Multiple cerebral infarctions and dementia as associated with anticardiolipin antibodies. Stroke 1987;18:1107-1112  https://doi.org/10.1161/01.STR.18.6.1107
  17. Westerman EM, Miles KM, Backonja M, Sundstrom WR. Neuropahtologic findings in multi-infarct dementia associated with anticardiolipin antibody. Arthritis Rheum 1992;9:1038-1041  https://doi.org/10.1002/art.1780350908
  18. Levin SR, Kieran S, Puzio K, et al. Cerebral venous thrombosis with lupus anticoagulants: report of two cases. Stroke 1987;18:801-804  https://doi.org/10.1161/01.STR.18.4.801
  19. Carhuapoma JR, Mitsias P, Levine SR. Cerebral venous thrombosis and antiphospholipid antibodies. Stroke 1997;28:2363-2369 https://doi.org/10.1161/01.STR.28.12.2363