Stroke In Young People With Antiphospholipid Syndrome: A Case Report And Review Of The Literature

ObjectiveTo analysis the role of antiphospholipid syndrome(APS) in the pathogenesis of stroke in young people, and to explore its etiology, pathogenesis, diagnosis and treatment. MethodsWe analysised a 28-year-old case of acute stroke,with multiple arterio - venous thrombosis,which was finally diagnosised as APS through detecting positive anticardiolipin antibodies (ACL) in serum and reviewed the related literatures to discuss its etiology, pathogenesis, diagnosisand treatment. ResultsThe syndrome with positive antiphospholipid antibodies(APL)and some other clinical symptoms such as the thrombosis of arteries or veins , the habitual abortion more than three times, thrombocytopenia was known as APS, which basic pathological changes is arterio - venous thrombosis.Main manifestation of APS is thrombosis , which can develop in any organ. The thrombosis can occur both in veins and in arteries,but venous thrombosis is more common. Thrombosis of cerebrial arteries account large part for arterial thrombosis. The patient suffered from thrombosis in veins of extremitas inferior and then acute cerebral infarction, which meet the manifestations of APS. The APL in serum which mainly include ACL and lupus anticoagulant (LA) is the key factor.The etiology and pathogenesis of APS is not completely understood, which maybe relate to genetic and infectious factors. Many kinds of phospholipids, phospholipid-binding protein and its complex could become the target antigen to APL.Those antigens are interfered by APL. Some APL can activate some vascular endothelial cells(ECs), which can continue to provoke FXII — mediated endogenous coagulation cascade reaction. Some can augment the expression of TF in surface of vascular ECs to initiate exogenous coagulation cascade reaction. Some antibodies can inhibit fibrinolytic system and protein C system and can promote the formation of atherosclerosis of the cardiovascular system. The results lead to thrombosis and the relevant clinical manifestations. This patient was young and lack of hypertension atherosclerosis and high cholesterol, diabetes and other risk factors, so we thought that the acute stroke was due to positive ACL. The diagnosis of APS is mainly on the basis of clinical manifestation and laboratory examination. This patient had multiple venous and arterial thrombosis and ACL of serum were twice positive with more than three months interval, so he was diagnosed as APS, but because anti-dsDNA and ANA of the patient were twice abnormal, we could not remove this phenomenon secondary to other autoimmune diseases. The therapeutic priciples of APS are symptomatic treatment ,prevention of the recurence of thrombosis and abortion, avoiding and reducing the risk factors of atherosclerosis,which include the treatment of thrombosis in its acute and chronic phase,the treatment of thrombocytopenia , the handling of pregnancy failure, the treatment of catastrophic APS. For secondary antiphospholipid syndrome, the treatment of the primary disease is also necessary . The main treatment of this patient in his acute stage of thrombosis, we first uesd Low Molecular Heparin and then Warfarin. In his chronic phage, we used Warfarin, and monitored INR, made it in the appropriate range of 2.0-3.0. We administered methylprednisolone, hydroxychloroquineand cyclophosphamide to treat abnormality of anti-dsDNA and ANA. In addition, symptomatic treatment and appropriate functional training were also needed. After three months of treatment, clinical manifestation improved. Complete aphasia was restored to normal communication with others. The muscle strength of right upper extremity recoveried from grade 0 to grade 4-5 of proximal end and grade 1-2 of distal end and the right lower extremity recoveried from grade 2 to grade 4-5.Warfarin was administered from 3mg/d to 6mg/d because INR was 1.32. ConclusionThe development of stroke in this patient was due to APS. The clinical manifestations are complicated and varied, including thrombosis of various organs and tissues, more than three times of the habitual abortion, thrombocytopenia, et al. The etiology and pathogenesis of APS is not completely understood. APL in serum is the key factor which can lead to thrombosis through various pathway. Diagnostic criteria of APS consist of clinical and laboratory standards. But there are a number of clinical cases of atypical clinical features that require attentions. The treatment include symptomatic treatment and prevention of thrombosis and recurrent abortion, avoiding and reducing the risk factors of atherosclerosis, treatment of catastrophic APS. Besides, it is necessary to treat the primary disease for secondary APS. APL is related with stroke, especially ischemic stroke in young people.Patients sufferring from APL -associated stroke are lack of hypertension and high cholesterol,diabetes and other risk factors. Because of multiple lesions and high recurrence rate, the harm is serious to the patients. It is important to diagnosis early, which can guide the treatment and prevention of the disease.