Complex movement disorders in primary antiphospholipid syndrome: A case report

Carecchio, Miryam; Comi, Cristoforo; Varrasi, Claudia; Stecco, Alessandro; Sainaghi, Pier Paolo; Bhatia, Kailash P.; Carriero, Alessandro; Cantello, Roberto; Monaco, Francesco

doi:10.1016/j.jns.2009.03.011

Cited by 16 publications

(10 citation statements)

References 15 publications

(18 reference statements)

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“…Other less frequent movement disorders previously described in APS include tics [20, 21], corticobasal syndrome [21, 22], hemidystonia [23, 24], paroxysmal nonkinesigenic dyskinesias [25], parkinsonism [26], cerebellar ataxia [27], and complex mixed presentations [28]. For a more comprehensive review on movement disorders in SLE and primary APS, see Baizabal-Carvallo [29].…”

Section: Neurological Manifestations In Apsmentioning

confidence: 99%

Revisiting the Molecular Mechanism of Neurological Manifestations in Antiphospholipid Syndrome: Beyond Vascular Damage

Carecchio

Cantello

Comi

2014

Journal of Immunology Research

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Antiphospholipid syndrome (APS) is a multiorgan disease often affecting the central nervous system (CNS). Typically, neurological manifestations of APS include thrombosis of cerebral vessels leading to stroke and requiring prompt initiation of treatment with antiplatelet drugs or anticoagulant therapy. In these cases, alterations of the coagulation system at various levels caused by multiple effects of antiphospholipid antibodies (aPL) have been postulated to explain the vascular damage to the CNS in APS. However, several nonvascular neurological manifestations of APS have progressively emerged over the past years. Nonthrombotic, immune-mediated mechanisms altering physiological basal ganglia function have been recently suggested to play a central role in the pathogenesis of these manifestations that include, among others, movement disorders such as chorea and behavioral and cognitive alterations. Similar clinical manifestations have been described in other autoimmune CNS diseases such as anti-NMDAR and anti-VGCK encephalitis, suggesting that the spectrum of immune-mediated basal ganglia disorders is expanding, possibly sharing some pathophysiological mechanisms. In this review, we will focus on thrombotic and nonthrombotic neurological manifestations of APS with particular attention to immune-mediated actions of aPL on the vascular system and the basal ganglia.

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Section: Neurological Manifestations In Apsmentioning

confidence: 99%

Revisiting the Molecular Mechanism of Neurological Manifestations in Antiphospholipid Syndrome: Beyond Vascular Damage

Carecchio

Cantello

Comi

2014

Journal of Immunology Research

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“…Different methods have been used to measure brain function: cerebral blood flow measurement using xenon‐133 inhalation method, technetium‐99m‐hexamethylpropylene amine oxime (HMPAO) or iodine‐123‐iodoamphetamine SPECT, [ 18 F]FDG PET, and magnetic resonance spectroscopy 36 . PET studies of glucose metabolism have identified fluctuating alterations in regional cerebral glucose uptake, oxygen consumption, and cerebral blood flow in NP‐SLE patients, even when no structural lesions were evident on MRI.…”

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confidence: 99%

PET/CT imaging in systemic lupus erythematosus

Curiel

Akin

Beaulieu

et al. 2011

Annals of the New York Academy of Sciences

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Systemic lupus erythematosus (SLE) is the classical immune-complex disease. Involvement of vital organs, particularly the kidneys and brain, accounts for significant morbidity and mortality. A number of imaging tools are currently available for evaluation of inflammatory conditions. By targeting the increased glucose uptake of infiltrating granulocytes and tissue macrophages, positron emission tomography with fluorine-18 fluorodeoxyglucose ([(18) F]FDG PET/CT) has been shown to delineate inflammation with high sensitivity. Because activated lymphocytes have increased glucose metabolism, [(18) F]FDG PET has been successfully used to visualize large concentrations of these cells in lymphoid organs where antigen presentation and lymphocyte activation occur. Widespread increased FDG uptake in lymph nodes of patients with active SLE, as well as increased thymic uptake, has been described. The most prevalent and dramatic PET/CT finding in neuropsychiatric SLE (NP-SLE) patients is parieto-occipital hypometabolism. In conclusion, PET/CT has become an excellent ancillary tool to assess disease activity and prognosis in SLE patients.

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“…Our patient was considerably older than previously reported patients with pre-APS syndrome, but primary APS has been reported in elderly females with an age ranging from 65 to 79 years. 14 , 22 , 23 Moderately raised titers of aPL have been reported in elderly patients with chorea and drug exposure, and immune and infectious disorders. 20 Our patient was in excellent health and did not have history of drug exposure or infection.…”

Section: Discussionmentioning

confidence: 99%