title: Antiphospholipid Syndrome of Late Onset: A Difficult Diagnosis of a Recurrent Embolic Stroke.
abstract: A 77-year-old woman with atrial fibrillation (AF) treated with warfarin had a cortical left middle cerebral artery (MCA) stroke (October 2009, international normalized ratio [INR], 1.6) and a cortical left frontal stroke (October 2011, INR, 1.9). Anticoagulation was adjusted. In October 2011, she had a right frontal stroke (INR, 2.3). Acetylsalicylic acid (ASA) was temporally added to the treatment. In June 2013, she had a left occipital stroke (INR, 2.3). Warfarin was changed to rivaroxaban. In August 2013, she had a right occipital stroke. ASA 100 was added to the treatment. On all occasions, repeated neurovascular studies and echocardiography were normal. Diagnoses were cardioembolic stroke. In November 2013, she was admitted because of a left MCA stroke. A complete blood analysis showed the presence of anticardiolipin, anti-b2-glycoprotein antibodies, and lupus anticoagulant. Primary antiphospholipid syndrome (APS) was later confirmed. APS should be considered in young stroke patients, however is not frequent in stroke patients older than 70 years with several cerebrovascular risk factors. The existence of AF in our patient with several embolic strokes made the cardiembolic etiology likely. Uncommon causes of stroke were not considered despite the repetition of the ischemic events. Thus, a wider etiological study should be made in all patients with a recurrent stroke regardless of age, such as a complete blood analysis including immunology study in order to exclude an APS of late onset.
authors.affiliation: Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain. Electronic address: mglezdelgado@yahoo.es.
authors.forename: Montserrat G
authors.initials: MG
authors.lastname: Delgado
authors.affiliation: Rheumatology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Neurology Department, Centro Médico de Asturias, Oviedo, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: García
authors.affiliation: Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Sánchez
authors.affiliation: Radiology Services, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sáiz
authors.affiliation: Neurology Service, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Calleja
mesh_terms: D000368:Aged; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis*; D001281:Atrial Fibrillation / Q000188:drug therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin; D000069552:Rivaroxaban
keywords: Antiphospholipid syndrome; anticoagulation; late onset; recurrent stroke