Cerebrovascular disease associated with antiphospholipid antibodies: more questions than answers

Hawkins Carolyn, Gatenby Paul, Tuck Roger, Danta Gytis, Andrews, Andrews Colin

Description

Neurological syndromes occur in a significant number of patients with antiphospholipid antibodies. The optimal management for these patients however remains uncertain. Our study is a descriptive analysis looking retrospectively at 45 patients who presented to the principal tertiary referral centre in the Australian Capital Territory, with either cerebral arterial or venous thrombosis for which there was no obvious cause for their presentation when initially reviewed. The diagnosis was based on the clinical findings made by one of three neurologists attached to our centre. Radiological findings and the presence of either IgM or IgG anticardiolipin antibodies, IgG anti-beta-2 glycoprotein 1 antibodies or a lupus anticoagulant were then documented. In this group of patients three subgroups were identified: 1. Individuals that fulfilled the Sapporo Classification Criteria 2. Individuals with transiently positive antiphospholipid antibodies and 3. Individuals with persistently low positive antiphospholipid antibodies. The most interesting of these three groups are those individuals with transiently positive antiphospholipid antibodies. A potential cause for presentation was identified in only one patient of this group with documented infective endocarditis and bacteraemia. Comparison with the other two groups suggested that there was little in terms of clinical presentation, radiological findings or intercurrent risk factors for thrombotic disease to distinguish between them. With disappearance of antiphospholipid antibodies, the individuals within this group have not had further thrombotic events. Our observations emphasise the problems that continue to exist in relation to the occurrence of cerebrovascular disease in the context of antiphospholipid antibodies and the optimal management of these stratified groups. Our findings also raise an as yet unanswered question as to the signficance of these transiently positive antiphospholipid antibodies. In the absence of significant intercurrent risk factors our findings would suggest that in the group we describe that they are likely to be of clinical significance.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2006
• Nombre de lectures: 3
• Langue: English

Extrait

Journal of Autoimmune Diseases

BioMedCentral

Open Access Research Cerebrovascular disease associated with antiphospholipid antibodies: more questions than answers 1,3 1,3 2 2 Carolyn Hawkins , Paul Gatenby* , Roger Tuck , Gytis Danta and 2 Colin Andrews

1 2 Address: Department of Clinical Immunology, The Canberra Hospital, Garran, Australia, Department of Neurology, The Canberra Hospital, 3 Garran, Australia and Australian National University Medical School (ANUMS), Australian National University, Acton, Australia Email: Carolyn Hawkins  [e-mail]; Paul Gatenby*  [e-mail]; Roger Tuck  [e-mail]; Gytis Danta  [e-mail]; Colin Andrews  [e-mail] * Corresponding author

Published: 30 March 2006 Received: 09 June 2005 Accepted: 30 March 2006 Journal of Autoimmune Diseases2006,3:3 doi:10.1186/1740-2557-3-3 This article is available from: http://www.jautoimdis.com/content/3/1/3 © 2006Hawkins et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Neurological syndromes occur in a significant number of patients with antiphospholipid antibodies. The optimal management for these patients however remains uncertain. Our study is a descriptive analysis looking retrospectively at 45 patients who presented to the principal tertiary referral centre in the Australian Capital Territory, with either cerebral arterial or venous thrombosis for which there was no obvious cause for their presentation when initially reviewed. The diagnosis was based on the clinical findings made by one of three neurologists attached to our centre. Radiological findings and the presence of either IgM or IgG anticardiolipin antibodies, IgG anti-beta-2 glycoprotein 1 antibodies or a lupus anticoagulant were then documented. In this group of patients three subgroups were identified: 1. Individuals that fulfilled the Sapporo Classification Criteria 2. Individuals with transiently positive antiphospholipid antibodies and 3. Individuals with persistently low positive antiphospholipid antibodies. The most interesting of these three groups are those individuals with transiently positive antiphospholipid antibodies. A potential cause for presentation was identified in only one patient of this group with documented infective endocarditis and bacteraemia. Comparison with the other two groups suggested that there was little in terms of clinical presentation, radiological findings or intercurrent risk factors for thrombotic disease to distinguish between them. With disappearance of antiphospholipid antibodies, the individuals within this group have not had further thrombotic events.

Our observations emphasise the problems that continue to exist in relation to the occurrence of cerebrovascular disease in the context of antiphospholipid antibodies and the optimal management of these stratified groups. Our findings also raise an as yet unanswered question as to the signficance of these transiently positive antiphospholipid antibodies. In the absence of significant intercurrent risk factors our findings would suggest that in the group we describe that they are likely to be of clinical significance.

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