What central nervous system (CNS) thrombotic manifestations can occur in patients with Antiphospholipid Antibodies?
Stroke is the most common CNS manifestation. aPL abs have been found in 5% to 10% of unselected patients with stroke and 45%–50% of patients aged <50 years with stroke. This gives a relative risk of 2.3 for aPL abs and stroke for all patients and 8.1 for young stroke patients. Notably, multiple strokes can lead to dementia.
Thrombosis can occur in other areas leading to ischemic optic neuropathy, retinal artery or vein occlusion, sensorineural hearing loss, chorea (1%), transverse myelitis (<1%), and cavernous or sagittal sinus thrombosis causing pseudotumor cerebri. Some patients with neurologic symptoms have been misdiagnosed as having multiple sclerosis based on brain magnetic resonance imaging (MRI) results. However, patients with aPL abs and neurologic symptoms usually have a normal IgG index and negative oligoclonal bands in their cerebrospinal fluid.