Cerebrovascular ischemic events with high positive anticardiolipin antibodies

Piero Verro, Steven R. Levine, Gretchen E. Tietjen

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85 Scopus citations

Abstract

Background and Purpose The aim of our study was to characterize the patient profile and prognostic value associated with high positive IgG (> 100 GPL) anticardiolipin antibodies (aCL). Methods - We studied the clinical, laboratory, radiological, and prospective historical features of ischemic cerebrovascular disease in patients with > 100 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(+) group had a significantly higher mean GPL than the LA(-) group (P=0.006). 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 (P=0.567). 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.

Original languageEnglish (US)
Pages (from-to)2245-2253
Number of pages9
JournalStroke
Volume29
Issue number11
StatePublished - Nov 1998
Externally publishedYes

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Keywords

  • Antibodies, anticardiolipin
  • Antibodies, antiphospholipid
  • Anticoagulants, lupus
  • Antiphospholipid syndrome
  • Cerebral ischemia, transient
  • Cerebrovascular disorders
  • Stroke
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Verro, P., Levine, S. R., & Tietjen, G. E. (1998). Cerebrovascular ischemic events with high positive anticardiolipin antibodies. Stroke, 29(11), 2245-2253.