Reversible Parkinsonism and Multiple Cerebral Infarctions after Pulmonary Endarterectomy in a Patient with Antiphospholipid Syndrome

Abstract

Antiphospholipid syndrome (APS) is a cause of chronic thromboembolic pulmonary hypertension (CTEPH) and it is associated with an increased risk of postoperative neurological complications. We experienced a case of reversible parkinsonism after pulmonary endarterectomy (PEA) and subsequent multiple cerebral infarctions under standard anticoagulation therapy in a patient with CTEPH associated with APS. Strict management using a combination of antiplatelet and anticoagulation therapy should be considered in patients with a high titer of triple antiphospholipid antibodies in the perioperative period. We should be aware of the high risk of postoperative neurologic manifestations in patients with APS.

Anaesthetic considerations for patients with antiphospholipid syndrome undergoing non-cardiac surgery

“…116 There is evidence of improvement of these manfiestations with anticoagulation, 117 however, in cases of persistent neurological symptoms despite anticoagulation therapy, the use of glucocorticoids is recommended. 118…”

“…116 There is evidence of improvement of these manfiestations with anticoagulation, 117 however, in cases of persistent neurological symptoms despite anticoagulation therapy, the use of glucocorticoids is recommended. 118 Postoperative bleeding is difficult to manage in patients with APS undergoing anticoagulation due to the underlying high risk of thrombosis. In particular, holding anticoagulation requires careful riskbenefit assessment.…”