Jamal Fares, Kumar Ravina, Hakobyan Narek
Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA.
Cureus. 2024 Jul 18;16(7):e64856. doi: 10.7759/cureus.64856. eCollection 2024 Jul.
We present an unusual case of antiphospholipid syndrome (APS) in a 31-year-old female patient exhibiting neuropsychiatric manifestations, followed by a subsequent thromboembolic stroke. APS is characterized by antiphospholipid antibodies leading to a prothrombotic state and an increased risk of thrombotic events. While the neurological involvement in APS typically presents with thrombotic events, antiphospholipid antibodies may also directly interact with neural tissue, causing immediate pathogenic effects that disrupt normal function. Neuropsychiatric manifestations in APS are rare but have been documented previously, including cases of psychosis and hallucinations. The timely recognition of APS in patients with neuropsychiatric symptoms is crucial for appropriate management and the prevention of further complications. The reported patient displayed aggressive, bizarre, and erratic behavior upon admission to the psychiatric unit, followed by the development of right-sided facial droop and weakness. Imaging studies revealed stenosis and partial occlusion of the left middle cerebral artery (MCA), and a repeat scan showed a known left MCA territory infarct with increasing hypodensity in specific brain regions. Notably, the patient exhibited multiple purpuric ecchymoses on bilateral upper extremities, raising suspicion of a hypercoagulable state. Laboratory investigations detected elevated levels of anticardiolipin IgG and beta-2 glycoprotein 1 IgG, along with a positive antinuclear antibody. The presence of a patent foramen ovale was also confirmed through echocardiography. This case emphasizes the importance of early APS recognition in patients with neuropsychiatric symptoms, facilitating appropriate intervention and improved outcomes. Further research is warranted to elucidate the underlying pathophysiological mechanisms connecting APS to neuropsychiatric manifestations, enabling enhanced understanding and refined management of this intricate condition.
我们报告了一例罕见的抗磷脂综合征（APS）病例，患者为一名31岁女性，出现神经精神症状，随后发生血栓栓塞性中风。APS的特征是抗磷脂抗体导致血栓前状态和血栓形成事件风险增加。虽然APS的神经系统受累通常表现为血栓形成事件，但抗磷脂抗体也可能直接与神经组织相互作用，产生立即破坏正常功能的致病作用。APS的神经精神症状罕见，但此前已有记录，包括精神病和幻觉病例。及时识别有神经精神症状的患者中的APS对于适当管理和预防进一步并发症至关重要。报告的患者入院时表现出攻击性、怪异和不稳定的行为，随后出现右侧面部下垂和无力。影像学研究显示左大脑中动脉（MCA）狭窄和部分闭塞，重复扫描显示已知的左MCA区域梗死，特定脑区低密度增加。值得注意的是，患者双侧上肢出现多处紫癜性瘀斑，怀疑存在高凝状态。实验室检查发现抗心磷脂IgG和β-2糖蛋白1 IgG水平升高，抗核抗体阳性。经超声心动图检查也证实存在卵圆孔未闭。该病例强调了在有神经精神症状的患者中早期识别APS的重要性，有助于进行适当干预并改善预后。有必要进行进一步研究以阐明将APS与神经精神症状联系起来的潜在病理生理机制，从而加深对这种复杂疾病的理解并优化管理。
