Primary Antiphospholipid Antibody Syndrome Complicated with Cerebellar Hemorrhage and Aortic Dissection: A Case Report
Autor: | Shigeru Shinozaki, Yui Mano, Yoshio Tatsuoka, Shuichi Ishikawa |
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Rok vydání: | 2019 |
Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Aortic Diseases 030204 cardiovascular system & hematology Nephropathy 03 medical and health sciences 0302 clinical medicine Cerebellar Diseases Antiphospholipid syndrome Internal medicine medicine Humans Renal replacement therapy Coma Renal Insufficiency Chronic Aortic dissection business.industry Warfarin Articles General Medicine Antiphospholipid Syndrome medicine.disease Thrombosis Prothrombin complex concentrate Aortic Dissection 030220 oncology & carcinogenesis Hypertension Cardiology Female business Intracranial Hemorrhages Kidney disease medicine.drug |
Zdroj: | The American Journal of Case Reports |
ISSN: | 1941-5923 |
Popis: | Patient: Female, 42-year-old Final Diagnosis: Primary antiphospholipid antibody syndrome Symptoms: Coma Medication: — Clinical Procedure: Evacuation of the intracranial hematoma • suboccipital decompression • intraventricular catheter placement Specialty: Neurosurgery Objective: Rare co-existance of disease or pathology Background: Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disease associated with arterial and venous thromboembolism and pregnancy complications. There have been several reports of APS with systemic lupus erythematosus (SLE) complicated with aortic dissection. However, none of them has been primary APS, which is APS without SLE. Case Report: A 42-year-old woman with primary APS and APS nephropathy on warfarin and aspirin therapy presented with coma due to cerebellar hemorrhage. The effect of warfarin was immediately reversed with prothrombin complex concentrate. We performed emergent evacuation of the hematoma, and her level of consciousness improved to normal on postoperative day (POD) 1. She had acute hypertension on arrival, which was resistant to multiple antihypertensives and was stabilized on POD 3. She also had exacerbation of chronic kidney disease after using contrast and prothrombin concentrate complex, and was on temporary renal replacement therapy from POD 3. Aortic dissection was found accidentally on echocardiography on POD 7, and she was subsequently treated medically. She was transferred to the rehabilitation hospital with mild dysarthria and truncal ataxia on POD 59. Conclusions: We report the first case in the English literature of primary APS complicated with cerebellar hemorrhage and aortic dissection. Acute hypertension following hemorrhage and exacerbation of APS nephropathy likely triggered the dissection of the aortic wall, the integrity of which might have been compromised by longstanding antiphospholipid antibody and vasa vasorum thrombosis. |
Databáze: | OpenAIRE |
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