Internal carotid artery occlusion and cerebral infarction in a case of juvenile systemic lupus erythematosus and positive for phosphatidylserine dependent antiprothrombin antibody

Abstract

Antiphospholipid antibodies are a major risk factor of juvenile cerebral infarction; in addition, they can cause major arterial stenosis or occlusion. We report a case of a 32-year-old man who had been diagnosed with systemic lupus erythematosus at the age of 20 years, and was admitted to Shin-Oyama City Hospital, Tochigi, Japan, because of left arm weakness. Cerebral infarction and occlusion of the right internal carotid artery were found. Tests were positive for phosphatidylserinedependent antiprothrombin antibody, which can be useful for the diagnosis of antiphospholipid syndrome. Phosphatidylserine-dependent antiprothrombin antibody might have the potential to cause thrombosis and vasculitis-like occlusion.

Internal Carotid Artery Occlusion in Systemic Lupus Erythematosus as a Potential Mimicker of Multiple Sclerosis

“…The ICA occlusion observed in the present case should be attributed to the comorbid NPSLE, while the exact underlying mechanisms of ICA occlusion in this case are unclear. Several possible pathophysiological mechanisms could be raised, such as premature atherosclerosis, thrombosis, vasculopathy, emboli, dissection of the carotid artery, and antiphospholipid syndrome [ 1 , 2 , 4 , 6 , 7 , 8 , 9 , 10 ]. There would have been atherosclerosis and thrombosis process following the chronic inflammation, and rarely, these pathological changes can result in ICA dissection [ 1 , 8 , 9 ].…”

“…The absence of significant pain in her neck or head does not exclude the possibility of an ICA dissection [ 9 ]. There was no evidence to support a diagnosis of antiphospholipid syndrome, which could potentially cause arterial stenosis or occlusion [ 4 , 6 , 10 ]. A similar previously reported case of SLE with ICA occlusion presented with positive antiphosphatidylserine/prothrombin antibodies [ 6 ]; however, we could not evaluate these antibodies and cannot rule out their presence in the present case [ 10 ].…”

“…There was no evidence to support a diagnosis of antiphospholipid syndrome, which could potentially cause arterial stenosis or occlusion [ 4 , 6 , 10 ]. A similar previously reported case of SLE with ICA occlusion presented with positive antiphosphatidylserine/prothrombin antibodies [ 6 ]; however, we could not evaluate these antibodies and cannot rule out their presence in the present case [ 10 ]. Although TA can rarely coexist with SLE [ 7 ], we consider the diagnosis of TA unlikely because of its characteristic distribution of large arterial lesions and rare involvement of ICA.…”

“…An echogram of her CA revealed an occlusion in her right extracranial ICA immediately above its origin, with a gradual narrowing of the vessel's internal cavity (Fig. 1e ), suggesting that a thrombosis was the cause of ICA occlusion [ 6 ]. There were no abnormal findings in her brachiocephalic trunk and common carotid arteries that suggested Takayasu arteritis (TA).…”

Clinical study of neurology nursing on cerebral apoplexy rehabilitation

“…Cerebral apoplexy is a clinically common cerebrovascular disease, mainly caused by atherosclerosis, vasospasm, abnormal blood circulation and ischemia and hypoxia of brain tissue [1]. Cerebral apoplexy patients mainly present with headache, dizziness, limb dysfunction, etc., which seriously affect the quality of life of patients.…”