Diagnostic and therapeutic problems in two patients with antiphospholipid antibodies, heart valve lesions, and transient ischaemic attacks.

Asherson, Ronald A.; Gibson, D. G.; Evans, D W; Baguley, Elaine; Hughes, G. R. V.

doi:10.1136/ard.47.11.947

Cited by 58 publications

(15 citation statements)

References 28 publications

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“…However, our data suggest a less strong association in Acla-positive patients be tween cardiac abnormalities and transient neurologic deficits than between cardiac ab normalities and stroke. A review of isolated case reports reveals a similar trend: 10 of 29 (34%) of all Acla-positive patients were found to have significant valve dysfunction compared to 70% of 26 cases with stroke [4,5,9,22,47,49]. Thus, among Acla-positive patients, while strokes most likely are em bolic, migraines and transient ocular or cere bral ischemic events may have other mecha nisms, perhaps representing a manifestation of a multifactorial vasospastic tendency in these patients.…”

Section: Discussionmentioning

confidence: 70%

Anticardiolipin Antibody and Stroke: Possible Relation of Valvular Heart Disease and Embolic Events

et al. 1991

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To establish the etiology of strokes related to the anticardiolipin antibody (Acla) syndrome and to determine the relationship of valvular heart disease and stroke in the presence of the Acla, clinical and objective characteristics of 21 patients with Acla, focal cerebral ischemic events were retrospectively analyzed. Twelve (86%) of 14 patients with stroke and 3 (42 %) of 7 patients with non-stroke cerebral ischemic events had echocardiographic evidence of left-sided valvular abnormalities. Features characteristic of cardioembolic stroke were present in 12 (86%) of the 14 patients with stroke. The strength of the association between valvular disease and stroke, combined with the clinical and radiologic features noted, suggest that strokes related to the Acla syndrome typically are embolic, from a cardiac source.

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Section: Discussionmentioning

confidence: 70%

Anticardiolipin Antibody and Stroke: Possible Relation of Valvular Heart Disease and Embolic Events

et al. 1991

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“…Livedo reticularis has also been associated.12 13 In comparison with the general SLE population an increased prevalence of heart valve lesions, particularly affecting the mitral and aortic valves, has recently been recorded in patients with these antibodies. [4][5][6][7][8][9][10][11][12][13][14][15][16] In addition, there have been case reports where the association appears to be prominent.17 18 This subject has recently been extensively reviewed.19 The antiphospholipid syndrome may manifest as a primary entity in the absence of any specific autoimmune disease2>22 but is more commonly seen in associa- We therefore conclude that patients with SLE and raised levels of anticardiolipin antibodies have a higher risk of developing occlusive ocular vascular disease than previously reported. In our group of patients features of the antiphospholipid syndrome were frequently present and in addition there was a high prevalence of central nervous system disease, particularly stroke.…”

Section: Discussionmentioning

confidence: 99%

Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the 'primary' antiphospholipid syndrome.

Asherson¹,

Merry²,

Acheson³

et al. 1989

Annals of the Rheumatic Diseases

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161

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“…Involvement of the endothelium of the cardiac valve may predispose to cardiac embolism as well. 9 The antiphospholipid syndrome (APS) consists of recurrent venous and arterial thrombotic events or recurrent fetal loss in the presence of a positive test for a lupus anticoagulant (LA) or aCL, independent of the presence of any single disease entity, such as systemic lupus erythematosus. 5 Accumulating data suggest that the IgG isotype of aCL is predominantly associated with the thrombotic complications of the APS.…”

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confidence: 99%

Cerebrovascular Ischemic Events With High Positive Anticardiolipin Antibodies

Verro¹,

Levine²,

Tietjen³

1998

Stroke

102

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Background and Purpose-The aim of our study was to characterize the patient profile and prognostic value associated with high positive IgG (Ͼ100 GPL) anticardiolipin antibodies (aCL). Methods-We studied the clinical, laboratory, radiological, and prospective historical features of ischemic cerebrovascular disease in patients with Ͼ100 GPL titers. From our neurology department, 27 consecutive patients were prospectively identified and followed up (mean follow-up time, 34 months). Results-The mean age of our cohort was 41 years. Lupuslike illness occurred in 3; 23 had primary antiphospholipid syndrome, including 3 who met criteria for Sneddon's syndrome; 1 patient had progressive systemic sclerosis. Cerebral infarcts occurred in 74% and were recurrent in 37%. Systemic ischemic events, most commonly deep vein thrombosis, occurred in 37%. Tobacco use was documented in 85%, hyperlipidemia in 74%, hypertension in 44%, and diabetes mellitus in 7% of patients. A prominent headache history was present in 67%. Lupus anticoagulant (LA) was present in 72%, approximately one half had positive antinuclear antibodies and thrombocytopenia, and one quarter had a false-positive VDRL. We compared mean GPL levels in patients testing positive for specific laboratory features of antiphospholipid syndrome with those testing negative for these parameters. Only the LA(ϩ) group had a significantly higher mean GPL than the LA(-) group (Pϭ0.006). Brain imaging showed nonlacunar infarcts in 73% and lacunes in 12%. Of 19 cerebral angiograms, 5 (26%) showed large-vessel occlusive disease and 6 (32%) branch obstruction. Echocardiograms were abnormal in 75%: thickened left-sided valves in 33% and vegetations in 12%. Recurrent cerebrovascular ischemic events were observed in 96%, with transient events (mean rate, 25%/y) occurring 5 times more frequently than strokes (mean rate, 5%/y). Using a standardized disability scale blinded to aCL titer, neurological impairment was severe in 7%, moderate in 30%, and mild or nonexistent in 63%, and unrelated to mean GPL value (Pϭ0.567). Titers fluctuated greatly for individual patients, and most did not consistently test as highly positive. An analysis of fluctuation in symptom severity with concurrent GPL values did not show a statistically significant correlation. Compared with historical controls having a wide range of positive titers, the presence of high IgG aCL titers did not confer a worse prognosis for disability and recurrent ischemic events. Conclusions-Our data suggest that cerebrovascular events associated with high positive GPL are frequently multiple and minor (with no disability-titer correlation), present in relatively young patients, and often associated with tobacco abuse, hyperlipidemia, LA, systemic ischemic events, and occult cardiac disease. (Stroke. 1998;29:2245-2253.)

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Diagnostic and therapeutic problems in two patients with antiphospholipid antibodies, heart valve lesions, and transient ischaemic attacks.

Cited by 58 publications

References 28 publications

Anticardiolipin Antibody and Stroke: Possible Relation of Valvular Heart Disease and Embolic Events

Anticardiolipin Antibody and Stroke: Possible Relation of Valvular Heart Disease and Embolic Events

Antiphospholipid antibodies: a risk factor for occlusive ocular vascular disease in systemic lupus erythematosus and the 'primary' antiphospholipid syndrome.

Cerebrovascular Ischemic Events With High Positive Anticardiolipin Antibodies

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