Antiphospholipid antibodies, lupus anticoagulant antibodies to cardiolipin, and a
false-positive result on testing for syphilis have been linked to thrombotic vascular
occlusions, particularly in patients with systemic lupus erythematosus (SLE) or lupus-like
disease, i.e., patients not fulfilling four American Rheumatism Association criteria
for the classification of SLE. The clinical and serologic features of 35 patients
with cerebrovascular disease (strokes/transient ischemic attacks) who demonstrated
antibodies to phospholipids are presented. Complete histories were obtained from all
35 patients, and all underwent routine physical examinations, radiography, electrocardiography,
computed tomographic brain scanning, and immunologic studies. Psychometric tests were
performed in nine patients.
The strokes were often multiple and were followed by multi-infarct dementia in nine
patients. Of particular interest were 10 patients in whom the presence of antiphospholipid
antibodies was the major and often the sole immunologic disturbance present. Several
of these patients were antinuclear antibody-negative, and the antinuclear antibodies,
when present, were usually of a low titer (1:40 to 1:160). These patients conform
to a group classified as having a primary antiphospholipid syndrome.
Antiphospholipid antibodies are strongly associated with cerebrovascular occlusions
in patients with SLE as well as in those with lupus-like disease and the primary antiphospholipid
syndrome. All patients with any of these conditions who present with vascular events
should be screened for these antibodies, as their occurrence may have a bearing on
future therapy.