CEREBRAL MICROEMBOLI IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME

CNS involvement is one of the hallmarks underlying poor prognosis in S LE and for therapeutic strategies it is difficult to assess which pati ents are at risk. As detectability of cerebral microembolic signals (M ES) using long-term transcranial Doppler ultrasonography (TCD) proved to be predictive of past and future thromboembolic events in patients with carotid artery stenosis, we investigated whether MES might be sim ilarly useful in patients with antiphospholipid syndrome (APS). Our st udy population consisted of 46 SLE patients and five with primary APS (pAPS). Twelve of the 46 patients with SLE, 10 of them with secondary APS (sAPS), and four of five patients with pAPS had a history of cereb rovascular ischaemia (CVI). MES in the middle cerebral artery were det ected in 14 of 16 patients with and in one of 35 without CVI (P < 0.00 1). Antiphospholipid antibodies (aPL) were positive in 12 of 15 patien ts with and 18 of 36 without MES, and the rate of MES correlated to th e titre of aPL. MES from APS patients resembled in their energy distri bution those from patients with symptomatic carotid disease and were s ignificantly different from those associated with artificial heart val ves. In conclusion, cerebral MES are detectable in APS patients and co rrelate with a history of CVI. Whether this innovative method may prov ide individual risk assessment in APS patients has to be addressed in prospective studies.