Postoperative parkinsonism and lupus anticoagulant: a model of autoantibody-mediated neurotoxicity in stress.
OBJECTIVE
Nigrostriatal hypodopaminergism is the fundamental basis in parkinsonism. It may arise secondarily from a variety of disorders but is rarely mentioned shortly after surgery.


METHODS
To report the clinical course of five patients who had had symptomatic parkinsonism developed shortly after surgery (lumbar laminectomy, prostatectomy and cholestectomy). Appropriate investigations were done to elucidate their pathogenesis.


RESULTS
There was no remarkable finding of their anesthetic agents, duration of surgery, type of surgery, medical conditions or preoperative screening test. Extensive investigations did not reveal consistent abnormality. However, an abnormal presence of lupus anticoagulant was detected in four patients; primary antiphospholipid antibody syndrome was fulfilled in two of them. The lupus anticoagulant restored to the reference range in another two patients later. Catastrophic antiphospholipid antibody syndrome was not seen. Initially, their parkinsonian symptoms rapidly progressed but slowed down after six months.


CONCLUSIONS
Lupus anticoagulant possesses neurotoxic property and has been found in cases of movement disorder involving with the central dopaminergism. Surgery, a form of traumatic stress, has been reported to bring on lupus anticoagulant and catastrophic antiphospholipid antibody syndrome. These relationships remind a generation or an enhancement of pathognomic autoantibody vulnerable for dopaminergic toxicity, such as lupus anticoagulant or other antiphospholipid antibody.
Chen
Wei-Hsi
WH
Department of Neurology, Chang Gung Memorial Hospital, Stroke Biology Research laboratory, Kaohsiung, Taiwan. e49130@ms14.hinet.net
Lin
Hung-Sheng
HS
Kao
Yin-Fen
YF
Lan
Min-Yu
MY
Liu
Jia-Shou
JS
D000368:Aged; D002781:Cholesteatoma / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects; D016682:Lupus Coagulation Inhibitor / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000097:blood / Q000209:etiology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000097:blood / Q000150:complications / Q000276:immunology*
D016682:Lupus Coagulation Inhibitor