Mj. Fulham et al., FOCAL CEREBRAL-ISCHEMIA AND ANTIPHOSPHOLIPID ANTIBODIES - A CASE FOR CARDIAC EMBOLISM, Acta neurologica Scandinavica, 90(6), 1994, pp. 417-423
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.