Primary Antiphospholipid Antibody Syndrome: Neuro radiologic Findings in 11 Patients

OBJECTIVE: To describe the neuroradiologic findings of primary antiphospholipid antibody syndrome (PAPS). MATERIALS AND METHODS: During a recent two-year period, abnormally elevated antiphospholipid antibodies were detected in a total of 751 patients. In any cases in which risk factors for stroke were detected-hypertension, diabetes mellitus, hyperlipidemia, smoking, and the presence of SLE or other connective tissue diseases-PAPS was not diagnosed. Neuroradiologic studies were performed in 11 of 32 patients with PAPS. We retrospectively reviewed brain CT (n = 7), MR (n = 8), and cerebral angiography (n = 8) in 11 patients with special attention to the presence of brain parenchymal lesions and cerebral arterial or venous abnormalities. RESULTS: CT or MR findings of PAPS included nonspecific multiple hyper-inten-sity foci in deep white matter on T2-weighted images (5/11), a large infarct in the territory of the middle cerebral artery (4/11), diffuse cortical atrophy (2/11), focal hemorrhage (2/11), and dural sinus thrombosis (1/11). Angiographic findings were normal (5/8) or reflected either occlusion of a large cerebral artery (2/8) or dural sinus thrombosis (1/8). CONCLUSION: Neuroradiologic findings of PAPS are nonspecific but in young or middle-aged adults who show the above mentioned CT or MR findings, and in whom risk factors for stroke are not present, the condition should be suspected.

Imaging Spectrum of Primary Antiphospholipid Antibody Syndrome

Antiphospholipid antibody syndrome is recognized as one of the most important causes of hypercoagulability. Itcan be clinically diagnosed if patients have experienced unexplained recurrent venous or arterial thrombosis,recurrent fetal loss, or thrombocytopenia in the presence of circulating autoantibodies to phospholipids, such asanticardiolipin antibody or lupus anticoagulant. Approximately half of all patients with this syndrome do not haveassociated systemic disease, and their condition is described as primary antiphospholipid antibody syndrome(PAPS). In the remainder, the syndrome is accompanied by systemic lupus erythematosus or other connective tissuediseases, and is known as secondary antiphospholipid syndrome (1). The purpose of this paper is to illustrate thesystemic manifestations of PAPS, focusing on the radiological findings of CT, MR and angiography in clinicallyproven patients.

Thrombolytic Treatment for Acute Ischemic Cerebral Stroke: Intraarterial Urokinase Infusion vs. Intravenous Heparin and Urokinase Infusion

PURPOSE: To evaluate the efficacy and limitation of intra-arterial urokinase (IAUK) infusion for treatment of acute cerebral stroke. MATERIALS AND METHODS: Twenty-seven acute cerebral stroke patients treated with IAUK infusion within six hours of stroke onset were reviewed. All patients showed normal initial brain findings on CT.In 21 patients, urokinase(5-15 X 105IU) was administered through a microcatheter placed into or proximal to occluded segment. Mechanical disruption of thrombus by guidewire was performed in 17 patients. Angiographic and clinical responses and complications after IAUK infusion, were evaluated and the results were compared with thoseof intravenous heparin(N=19) and urokinase infusion(n=19). RESULTS: Complete or partial angiographic recanalization of occluded segment was found in 18 patients(67%), and neurologic improvement was followed in 14patients(52%). The degree of improvement on the stroke scale score after IAUK infusion was statistically more significant(p<0.05) than that shown after intravenous heparin and urokinase infusion. Complications after IAUK infusion were large(15%) and small amount intracerebral hemorrhage(15%), contrast leakage into brain parenchyma(11%), and gastrointestinal bleeding(4%). Between the IAVK and the intravenous urokinase infusion group, differences in extent and types of complications were statistically insignificant, but were significantly higherin those two groups than in the intravenous heparin infusion group. CONCLUSION: IAUK infusion may be effectivefor the treatment of acute cerebral stroke.

The Modified Pulse-Spray Method Using Urokinase in Subacute and Chronic Thrombotic Arterial Occlusion

PURPOSE: To evaluate the effectiveness and safety of the modified pulse-spray method using Urokinase (UK) in subacute and chronic thrombotic arterial occlusion. MATERIALS AND METHODS: Modified pulse-spray methods using UKwere performed in seven patients with subacute (1week-1month) to chronic (1 month-5years) occlusive sysmptoms suchas limb pain, claudication and impotence. Angiographic examination revealed thrombotic occlusion of the aorta, common iliac arteries, brachial arterio-venous hemodialysis graft and femoro-popliteal bypass graft. The patients underwent thrombolysis using modified pulse-spray and additional constant infusion of UK. In the presence of underlying stenosis or organized clots, balloon angioplasty or stent placement was performed. RESULTS: Completelysis was obtained in five of seven patients. For initial lysis, the mean dose of UK was 420,000 units, and the mean modified pulse-spray time was 50 minutes. Mean total dose of UK and mean total time for complete lysis were 800,000 units and 161 minutes, respectively. Thrombolysis of the femoro-popliteal bypass graft failed due to severe occlusion of the distal anastomosis. Partial lysis was achieved in one patient with aorto-iliac occlusion, but further thrombolysis was stopped due to bleeding at the puncture site. CONCLUSION: The modified pulse-spraymethod using UK is effective in treating subacute and chronic arterial thrombotic occlusion. It augments the speed, safety and efficacy of thrombolysis. When underlying stenosis or organized clots remain after thrombolysis, balloon angioplasty or stent placement would be helpful.