[Transient elevation of the number of microembolic signal in a patient with primary antiphospholipid antibody syndrome].
We report a 55-year-old man complaining of monoparesis of the right arm and dementia. Brain magnetic resonance imaging (MRI) demonstrated multiple foci of fresh cerebral embolism. The serum lupus anticoagulant was positive, however, the serum anticardiolipin antibody and other autoantibodies indicating connective tissue diseases were negative. This patient received a diagnosis of primary antiphospholipid antibody syndrome. Transcranial Doppler(TCD) monitoring of the middle cerebral artery showed the presence of microembolic signal (MES). We initiated anticoagulant therapy with intravenous heparin administration, and three days later we added oral warfarin administration. We used both warfarin and heparin together for only three days. The number of MES increased transiently after initiating of warfarin administration, then decreased by warfarin therapy with production of an international normalized ratio (INR) of prothrombin time over 2. His neurological symptoms normalized except for monoparesis of the right arm. There were no foci of fresh cerebral infarct disclosed on brain MRI performed two months after admission. The treatment strategy for antiphospholipid antibody (APS) patients has not yet been established. Some reports and guideline recommended that the stroke patients with APS should be treated with long-term oral anticoagulant therapy, target INR 2.5 (optimal range 2.0 to 3.0). In this patient, we confirmed a decrease in the number of MES by warfarin therapy with production of INR over 2. In APS patients, detection of MES by TCD is a useful device for adjustment of the warfarin dose. Concerning the course of MES and warfarin therapy, transient elevation of the number of MES after initiation of warfarin therapy would suggest the hypercoagulability due to an acute decrease in serum protein C level. Using the TCD technique, we detected such hypercoagulability for the first time.
Sakai
Kenji
K
Department of Neurology, National Saigata Hospital, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
Nakajima
Takashi
T
Fukuhara
Nobuyoshi
N
D000925:Anticoagulants / Q000008:administration & dosage*; D016736:Antiphospholipid Syndrome / Q000150:complications*; D001921:Brain / Q000473:pathology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017585:Ultrasonography, Doppler, Transcranial; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin