CEREBROVASCULAR ISCHEMIC EVENTS WITH HIGH POSITIVE ANTICARDIOLIPIN ANTIBODIES

Background and Purpose-The aim of our study was to characterize the pa tient profile and prognostic value associated with high positive IgG ( >100 GPL) anticardiolipin antibodies (aCL). Methods-We studied the cli nical, laboratory, radiological, and prospective historical features o f ischemic cerebrovascular disease in patients with >100 GPL titers. F rom our neurology department, 27 consecutive patients were prospective ly identified and followed up (mean follow-up time, 34 months). Result s-The mean age of our cohort was 41 years. Lupuslike illness occurred in 3; 23 had primary antiphospholipid syndrome, including 3 who met cr iteria for Sneddon's syndrome; 1 patient had progressive systemic scle rosis. Cerebral infarcts occurred in 74% and were recurrent in 37%. Sy stemic ischemic events, most commonly deep vein thrombosis, occurred i n 37%. Tobacco use was documented in 85%, hyperlipidemia in 74%, hyper tension in 44%, and diabetes mellitus in 7% of patients. A prominent h eadache history was present in 67%. Lupus anticoagulant (LA) was prese nt in 72%, approximately one half had positive antinuclear antibodies and thrombocytopenia, and one quarter had a false-positive VDRL. We co mpared mean GPL levels in patients testing positive for specific labor atory features of antiphospholipid syndrome with those testing negativ e for these parameters. Only the LA(+) group had a significantly highe r mean GPL than the LA(-) group (P=0.006). Brain imaging showed nonlac unar infarcts in 73% and lacunes in 12%. Of 19 cerebral angiograms, 5 (26%) showed large-vessel occlusive disease and 6 (32%) branch obstruc tion. Echocardiograms were abnormal in 75%: thickened left-sided valve s in 33% and vegetations in 12%. Recurrent cerebrovascular ischemic ev ents were observed in 96%, with transient events (mean rate, 25%/y) oc curring 5 times more frequently than strokes (mean rate, 5%/y). Using a standardized disability scale blinded to aCL titer, neurological imp airment was severe in 7%, moderate in 30%, and mild or nonexistent in 63%, and unrelated to mean GPL value (P=0.567). Titers fluctuated grea tly for individual patients, and most did not consistently test as hig hly positive. An analysis of fluctuation in symptom severity with conc urrent GPL values did not show a statistically significant correlation . Compared with historical controls having a wide range of positive ti ters, the presence of high IgG aCL titers did not confer a worse progn osis for disability and recurrent ischemic events. Conclusions-Our dat a suggest that cerebrovascular events associated with high positive GP L are frequently multiple and minor (with no disability-titer correlat ion), present in relatively young patients, and often associated with tobacco abuse, hyperlipidemia, LA, systemic ischemic events, and occul t cardiac disease.