title: Catastrophic cerebral antiphospholipid syndrome presenting as cerebral infarction with haemorrhagic transformation after sudden withdrawal of warfarin in a patient with primary antiphospholipid syndrome.
abstract: Catastrophic antiphospholipid syndrome (APS) is caused by thrombotic vascular occlusions that affect both small and large vessels, producing ischaemia in the affected organs. The "catastrophic" variant of the antiphospholipid syndrome (cAPS) develops over a short period of time. Although patients with cAPS represent <1% of all patients with APS, they are usually life threatening with a 50% mortality rate. A strong association with concomitant infection is thought to act as the main trigger of microthromboses in cAPS. Several theories have been proposed to explain these physiopathological features. Some of them suggest the possibility of molecular mimicry between components of infectious microorganisms and natural anticoagulants, which might be involved in the production of cross-reacting antiphospholipid antibodies. We present a case of catastrophic cerebral APS characterised by massive temporal lobe infarction and subsequent haemorrhagic transformation after sudden withdrawal of warfarin.
authors.affiliation: Hera General Hospital, Medicine, 4a/201, Makkah, Western, 21955, Saudi Arabia.
authors.forename: Abdul Majid
authors.initials: AM
authors.lastname: Wani
authors.forename: Waleed Mohd
authors.initials: WM
authors.lastname: Hussain
authors.forename: Mousa Ali Al
authors.initials: MA
authors.lastname: Mejally
authors.forename: Khaled Shawkat
authors.initials: KS
authors.lastname: Ali
authors.forename: Sadeya Hanif
authors.initials: SH
authors.lastname: Raja
authors.forename: Wael Al
authors.initials: WA
authors.lastname: Maimani
authors.forename: Mazen G
authors.initials: MG
authors.lastname: Bafaraj
authors.forename: Ashraf
authors.initials: A
authors.lastname: Bashraheel
authors.forename: Mubeena
authors.initials: M
authors.lastname: Akhtar
authors.forename: Amer Mohd
authors.initials: AM
authors.lastname: Khoujah