Cerebrovascular Ischemic Events With High Positive Anticardiolipin Antibodies

Abstract

Background and Purpose-The aim of our study was to characterize the patient profile and prognostic value associated with high positive IgG (Ͼ100 GPL) anticardiolipin antibodies (aCL). Methods-We studied the clinical, laboratory, radiological, and prospective historical features of ischemic cerebrovascular disease in patients with Ͼ100 GPL titers. From our neurology department, 27 consecutive patients were prospectively identified and followed up (mean follow-up time, 34 months). Results-The mean age of our cohort was 41 years. Lupuslike illness occurred in 3; 23 had primary antiphospholipid syndrome, including 3 who met criteria for Sneddon's syndrome; 1 patient had progressive systemic sclerosis. Cerebral infarcts occurred in 74% and were recurrent in 37%. Systemic ischemic events, most commonly deep vein thrombosis, occurred in 37%. Tobacco use was documented in 85%, hyperlipidemia in 74%, hypertension in 44%, and diabetes mellitus in 7% of patients. A prominent headache history was present in 67%. Lupus anticoagulant (LA) was present in 72%, approximately one half had positive antinuclear antibodies and thrombocytopenia, and one quarter had a false-positive VDRL. We compared mean GPL levels in patients testing positive for specific laboratory features of antiphospholipid syndrome with those testing negative for these parameters. Only the LA(ϩ) group had a significantly higher mean GPL than the LA(-) group (Pϭ0.006). Brain imaging showed nonlacunar infarcts in 73% and lacunes in 12%. Of 19 cerebral angiograms, 5 (26%) showed large-vessel occlusive disease and 6 (32%) branch obstruction. Echocardiograms were abnormal in 75%: thickened left-sided valves in 33% and vegetations in 12%. Recurrent cerebrovascular ischemic events were observed in 96%, with transient events (mean rate, 25%/y) occurring 5 times more frequently than strokes (mean rate, 5%/y). Using a standardized disability scale blinded to aCL titer, neurological impairment was severe in 7%, moderate in 30%, and mild or nonexistent in 63%, and unrelated to mean GPL value (Pϭ0.567). Titers fluctuated greatly for individual patients, and most did not consistently test as highly positive. An analysis of fluctuation in symptom severity with concurrent GPL values did not show a statistically significant correlation. Compared with historical controls having a wide range of positive titers, the presence of high IgG aCL titers did not confer a worse prognosis for disability and recurrent ischemic events. Conclusions-Our data suggest that cerebrovascular events associated with high positive GPL are frequently multiple and minor (with no disability-titer correlation), present in relatively young patients, and often associated with tobacco abuse, hyperlipidemia, LA, systemic ischemic events, and occult cardiac disease. (Stroke. 1998;29:2245-2253.)

Anticardiolipin Antibodies Are Not an Independent Risk Factor for Stroke

“…Another study 12 showed that individuals with IgG-aCL of Ͼ40 GPL units had more prior strokes and more frequent subsequent thrombo-occlusive events and death, whereas still another study 13 reported that the presence of aCL did not confer an increased risk for subsequent thromboocclusive events and death. In a recent study, 14,15 cerebro-vascular events were associated with high levels of IgGaCL (Ͼ100 GPL) in relatively young adults.…”

Evaluation of the Different Antiphospholipid Antibodies for the Diagnosis of Antiphospholipid Syndrome

“…These and other studies, however, appear to reach a consensus that although generally GPL and LAC show a good correlation among themselves and with the thrombotic manifestations of APS, mainly thrombosis, LAC correlates much more with venous thrombosis [27,28]. Some studies have shown a correlation of the IgA isotype of aCL with thrombocytopenia [29] while the IgM isotype of aCL has been shown to correlate with auto-immune haemolytic anaemia [30].…”

Ischemic and nonischemic manifestations of antiphospholipid syndrome

“…Данные проявления не считают клиническими критериями, но их наличие в совокупности с аФЛ представляет собой важный диагностический фак-тор для детей с АФС [4,9,46].…”

“…Головные боли, включая мигрень, и ишемические инсуль-ты являются главными неврологическими про-явлениями АФС [15,19]. Были изучены и дока-заны влияния таких факторов, как пол, наличие или отсутствие мигрени в семейном анамнезе, использование пероральных контрацептивов, вы-сокое артериальное давление, сахарный диабет, заболевания сердца и курение, на возникновение неврологической симптоматики при АФС [36,46]. Наличие аФЛ -доказанный фактор риска развития инсультов, при этом исследование плаз-менного звена гемостаза необходимо проводить всем молодым людям с мигренью и пациентам до 50 лет с инсультом в анамнезе.…”