title: Neurosurgical management for complicated catastrophic antiphospholipid syndrome.
abstract: Antiphospholipid syndrome (APS) is an autoimmune condition involving arterial and venous thrombosis. An unusual APS variant, catastrophic antiphospholipid syndrome (CAPS), includes rapid multi-organ failure from widespread small vessel thrombosis. Central nervous system complications arise in one-third of CAPS patients. In rare cases, CAPS co-manifests with cerebellar hemorrhage presenting a neurosurgical emergency. We present a 65-year-old woman with CAPS-related cerebellar hematoma, co-morbid idiopathic thrombocytopenic purpura, deep vein thrombosis and altered mental status, with treatment complicated by thrombocytopenia. The patient suddenly deteriorated, secondary to a cerebellar subdural hematoma, and underwent decompression and excision of the hematoma. After recovery in the intensive care unit, she developed a new spontaneous epidural hematoma requiring additional surgery. Management of these patients is hematologically complex and often requires a multi-disciplinary team of physicians. This patient provides an important learning point for clinicians - consider CAPS when hemorrhage and thrombosis are present.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA. Electronic address: doniel.drazin@gmail.com.
authors.forename: Doniel
authors.initials: D
authors.lastname: Drazin
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: H
authors.initials: H
authors.lastname: Westley Phillips
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Shirzadi
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Noam
authors.initials: N
authors.lastname: Drazin
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: Wouter
authors.initials: W
authors.lastname: Schievink
mesh_terms: D000368:Aged; D016736:Antiphospholipid Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D001921:Brain / Q000000981:diagnostic imaging / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019635:Neurosurgical Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Antiphospholipid syndrome; Catastrophic illness; Cerebellar subdural hemorrhage; Intracerebral hemorrhage; Laminectomy; Suboccipital craniotomy