Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review

Al-Banaa, Kadhim; Alshaikhli, Alfarooq; AL-Hareeri, Asal; Abdelhalim, Mohammed; Al-Hillan, Alsadiq; Joshi, Tejas P

doi:10.12890/2021_002610

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…Thrombosis is thought to be the most common mechanism, with intracranial large arteries, particularly the middle cerebral artery (MCA), being the most common site of occlusion. 10 Embolism from valvular heart disease (Libman–Sacks endocarditis), extracranial carotid artery lesions, 11 vasculitis-like manifestations, 12 chronic occlusive vasculopathy affecting small- and medium-sized intracerebral arteries, 13 and carotid or vertebral artery dissection 14 are also described.…”

Section: Aps-associated Cerebrovascular Disordersmentioning

confidence: 99%

Antiphospholipid syndrome, antiphospholipid antibodies, and stroke

Mittal

Quattrocchi

Tohidi‐Esfahani

et al. 2023

International Journal of Stroke

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Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disease with heterogenous clinicopathological manifestations and is a well-established cause of acute ischaemic stroke (AIS) and transient ischaemic attack (TIA), particularly in younger patients. There is growing recognition of a wider spectrum of APS-associated cerebrovascular lesions, including white matter hyperintensities, cortical atrophy and infarcts, which may have clinically important neurocognitive sequalae. Diagnosis of APS-associated AIS / TIA requires expert review of clinical and laboratory information. Management also poses challenges, given the potential for substantial morbidity and recurrent thrombosis, additional risk conferred by conventional cardiovascular risk factors, and limitations in the evidence-base regarding optimal antithrombotic therapy for secondary prevention. In this review, we summarise key features of APS-associated cerebrovascular disorders, with focus on clinical and laboratory aspects of diagnostic evaluation, including practical guidance for antiphospholipid antibody (aPL) testing, and an overview of neuroimaging findings. The current status of prognostic markers is considered. We review the evidence base for antithrombotic treatment in APS-associated stroke and discuss ongoing uncertainties in this setting, including the optimal intensity of anticoagulation and efficacy of direct oral anticoagulants (DOACs). Clinical practice recommendations are provided, covering antithrombotic treatment, supportive management and options for anticoagulant-refractory cases, and we highlight the benefits of adopting a careful multidisciplinary team approach.

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Section: Aps-associated Cerebrovascular Disordersmentioning

confidence: 99%

Antiphospholipid syndrome, antiphospholipid antibodies, and stroke

Mittal

Quattrocchi

Tohidi‐Esfahani

et al. 2023

International Journal of Stroke

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“…Internal carotid artery dissection is strongly associated with trauma [ 19 , 20 , 21 ], but it also occurs without any tangible connection with any trauma [ 14 , 22 , 23 , 24 ]. The haematoma dissecting the arterial wall penetrates between the middle and the inner membrane causing the inner membrane to bulge into the lumen of the artery.…”

Section: Discussionmentioning

confidence: 99%

“…The CT-angiography (CTA) of the aorta and renal arteries did not reveal any evidence of fibromuscular dysplasia. No data were found for this disease in the image of the cerebral arteries [ 13 , 14 , 15 , 16 ]. In addition, there were no radiological features of Eagle syndrome [ 17 ] based on the CTA of the neck ( Figure 4 ).…”

Section: Case Presentationmentioning

confidence: 99%

Acute Tongue Swelling as a Still Unexpected Manifestation of Internal Carotid Artery Dissection: A Case Report

et al. 2023

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The diagnosis of internal carotid artery dissection (ICAD) at the stage of local signs is essential in the prevention of the life-treating cerebral complication; however, making this diagnosis has significant difficulties. We present the case of a 36-year-old female with left ICAD with asymmetric left-sided tongue swelling as an unusual and still unexpected symptom. The patient’s complaints at admission were left-sided numbness of the tongue and swallowing difficulties but its movements were intact. Despite the provided treatment for suspected angioedema, no improvement was noted. Additional examination revealed left-sided tongue weakness, ipsilateral soft palate palsy, paralysis and reduced tension of the left vocal fold, and left-sided Horner’s syndrome. Another suspected diagnosis was a dysfunction of the IX, X, and XII cranial nerves. A head MRI revealed an intramural hematoma of the left internal carotid artery. The radiologists suggested ICAD. The angio-MRI of the head arteries confirmed this diagnosis. The patient received dual antiplatelet therapy. The neuro-logopaedic therapy was also implemented. Currently, the patient’s symptoms are gradually improving with significantly better results on follow-up neuroimaging. Among the possible local symptoms of ICAD, proper attention should be paid to asymmetric swelling of the tongue as an atypical manifestation of damage to the hypoglossal nerve.

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“…in 21 cases associated with APS, including five cases involving the coronary artery, five with the vertebral artery, four in the aorta, three in the carotid artery, three in the cerebral artery, and one in the femoral artery. 2 All of the previous case reports described a single arterial dissection complicating the course of APS. In contrast, our patient developed multiple dissections within a span of 2 weeks as part of a probable CAPS episode.…”

Section: Nonthrombotic Spontaneous Dissection Of Arteries Has Been Re...mentioning

confidence: 99%

“…of the carotid or vertebral arteries resulting in cerebral infarction. 2 However, arterial dissection has not been described in the context of catastrophic APS (CAPS), despite the fact that patients with CAPS should be at substantial risk for vascular injury and dissection due to the high intensity of inflammation typically observed in CAPS. Here, we describe a female patient with a history of recurrent miscarriage who presented with spontaneous dissection of the coronary artery and abdominal aorta, as well as multiorgan thrombosis.…”

mentioning

confidence: 99%

A warning before the storm: Spontaneous dissection of coronary artery and abdominal aorta in a patient with recurrent miscarriages

Sangkamanovet,

Saengboon,

Thitiarayavich

et al. 2023

Int J of Rheum Dis

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Spontaneous arterial dissection is a rare condition that has been associated with young females, pregnancy, and fibromuscular dysplasia, often occurring without typical cardiovascular risk factors. 1 The association between arterial dissection and autoimmune rheumatic diseases has rarely been described. There have been a few reports of arterial dissections associated with antiphospholipid syndrome (APS), the majority of which involved dissections

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Arterial Dissection in Antiphospholipid Syndrome Patients: Two Case Reports and a Literature Review

Cited by 6 publications

References 25 publications

Antiphospholipid syndrome, antiphospholipid antibodies, and stroke

Antiphospholipid syndrome, antiphospholipid antibodies, and stroke

Acute Tongue Swelling as a Still Unexpected Manifestation of Internal Carotid Artery Dissection: A Case Report

A warning before the storm: Spontaneous dissection of coronary artery and abdominal aorta in a patient with recurrent miscarriages

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