FOCAL CEREBRAL-ISCHEMIA AND ANTIPHOSPHOLIPID ANTIBODIES - A CASE FOR CARDIAC EMBOLISM

We report clinical, neuroimaging and immunological findings in seven w omen with antiphospholipid antibodies (APLA) and cerebral ischemia. Tw o patients had systemic lupus erythematosus (SLE) and five had the ant iphospholipid syndrome (APS). Autopsies were done in 3 women who died acutely with focal neurological deficits. Evidence for cerebral emboli sm was found in all patients: a) pathology demonstrated multiple cereb ral infarctions and cerebral emboli from underlying non-bacterial thro mbotic endocarditis (NBTE) in the patients who died, b) Three patients had thickened mitral valves and embolic cerebral occlusions were iden tified with cerebral angiography. c) In one patient, echocardiography detected a thrombus on the posterior leaflet of a prolapsing mitral va lve at the time of ictus. Our data provide further evidence to implica te valvular endothelium in the genesis of cerebral ischemia in some pa tients with APLA.