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Antiphospholipid Syndrome
December 2003

Q. My 19-year-old daughter is currently a patient at UCLA. She had a stroke approximately 3 years ago due to an arterial infarction tentatively determined to be caused by an immune disorder (antiphospholipid syndrome) which created blood clots.

Since then, she has had several strokes and TIAs but remained ambulatory as well as recovering the majority of her mental faculties. A couple of weeks ago she began complaining of chronic dizziness and weakness and we took her back to UCLA. After CAT scans, MRIs and brain Doppler they determined that she had had numerous TIAs since her initial stroke event and that the middle cerebral artery was occluded to the point that there was minimal blood flow.

The artery is occluding of it's own accord. Moyamoya would seem a possibility but the arteries are not trying to create new vessels for blood supply. Apparently the neurosurgeon has ruled out using stents. We have a team of surgeons that have no consensus of opinion for this very dire situation. Do you have any references, research or any other material that might shed some light on this situation?

A. Anti-phospholipid syndrome is one of a group of auto-immune diseases in which the body forms antibodies against its own tissue. Common examples of auto-immune diseases include type I diabetes, multiple sclerosis, and rheumatoid arthritis. The cause of this condition is not known and it is not entirely clear how this leads to blood clotting.

Treatment is aimed at anticoagulation therapy to prevent clotting, steroid drug therapy to suppress the abnormal immune response, and recently attempts at plasma exchange to remove the abnormal antibodies. Despite these efforts, treatment effectiveness is far from optimal.

Here are some recently published medical reports that can be obtained from a hospital or medical school library, and two websites for further reference.

Treatment of the antiphospholipid syndrome. N Engl J Med. 2003 Sep 18;349(12):1177-9.

A comparison of two intensities of warfarin for the prevention of recurrent thrombosis in patients with the antiphospholipid antibody syndrome. N Engl J Med. 2003 Sep 18;349(12):1133-8.

http://www.niams.nih.gov/hi/topics/autoimmune/autoimmunity.htm

http://www.aarda.org/common_thread_art.html

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