Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

Abstract

A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

Cerebral artery dissection secondary to antiphospholipid syndrome: A report of two cases and a literature review

“…3,4 The current study highlighted the eight previous cases and the present two cases with APS developing cervical and cranial artery dissections that had common clinical characteristics, including young age, female preponderance, and few atherosclerotic risk factors, which was more evident compared to overall APS patients with ischemic stroke, as well as all CAD cases. 6,8–14 Interestingly, the current study explored the fact that previous cases reported from Western countries predominantly involved the ICA, whereas the present two cases had bilateral VAD, which was consistent with ethnic variations in overall CAD. It has been suggested that arterial endothelial dysfunction owing to the interaction between antiphospholipid antibodies and endothelial cells might contribute to the development of dissection, with coexisting local vasculitis and increased shear stress.…”

Neurologic manifestations of antiphospholipid syndrome

“…30 The natural progression of carotid extracranial stenosis in APS in unknown. 31 Cerebral embolism in APS is associated with left cardiac valvular abnormalities and, rarely, intracardiac thrombus. 13 The valvular pathologies include irregular thickening of the valve leaflets due to deposition of immune complexes, vegetations (Libman-Sacks endocarditis), and valve dysfunction.…”

Parotid swelling due to external carotid artery thrombus—a rare manifestation in antiphospholipid syndrome

“…But we did not find any such case of external carotid artery involvement within parenchyma of parotid, causing unilateral gland swelling. Mahale et al [5] reported a case of right-sided internal carotid artery thrombus with right lower limb deep vein thrombosis in a 38-year-old female who had a history of 2nd trimester pregnancy loss and was later diagnosed as APS, and Anand et al [6] cited a 39-year-old female patient with stroke due to bilateral involvement of the same in relation with APS. Etiologies of parotid swelling can be divided as infectious, non-infectious, benign and malignant.…”