title: Antiphospholipid syndrome and multiple ischemic strokes in a patient with myasthenia gravis.
abstract: Little is known about ischemic stroke occurrence in patients with myasthenia gravis (MG), although antiphospholipid antibodies are detectable in many MG patients. A 47-year-old woman with a 20-year history of generalized MG had an acute onset of right hemiparesis. She had undergone thymectomy 10 years previously and was treated for phlebothrombosis of the lower extremity 3 years previously. Computed tomography (CT) demonstrated an old infarct in the left frontal lobe and a new lesion in the right parietal lobe. Multiple small cortical and subcortical infarcts were demonstrated on fluid attenuated inversion recovery (FLAIR) images. Thrombocytopenia (5.9 x 10(4)/microL), a prolonged activated partial thromboplastin time (aPTT; 50.2 sec), and an elevation of beta 2-IgG-glycoprotein I anticardiolipin antibodies (beta 2-GPIaCL; 55.7 U/mL) were observed. Neurological defects improved significantly over 2 weeks. She then was treated with oral prednisolone (30 mg/day) for 18 months, with resolution of laboratory abnormalities and no new cerebrovascular events or findings on imaging. We believe that our patient's multiple infarcts are caused by antiphospholipid antibodies and recommend glucocorticoid therapy to prevent recurrent of ischemic stroke in similar case.
authors.affiliation: Department of Neurology, Center for Rheumatic Diseases, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume 839-0863, Japan. mkaji@ktarn.or.jp
authors.forename: Masahide
authors.initials: M
authors.lastname: Kaji
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sato
authors.forename: Haruko
authors.initials: H
authors.lastname: Kunoh
authors.forename: Aya
authors.initials: A
authors.lastname: Watanabe
authors.forename: Hisamichi
authors.initials: H
authors.lastname: Aizawa
authors.forename: Kotaro
authors.initials: K
authors.lastname: Oizumi
authors.forename: Toshi
authors.initials: T
authors.lastname: Abe
mesh_terms: D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications*; D011239:Prednisolone / Q000627:therapeutic use; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone