Ischemic and nonischemic manifestations of antiphospholipid syndrome

Abstract

Hypercoagulability syndrome is an actual multidisciplinary problem of the last decade. Blood clotting disorders leading to hypercoagulability syndrome may manifest as different diseases in neurology, obstetrics, rheumatology, surgery, including diseases of pregnancy. Antiphospholipid syndrome is the most common form of hypercoagulability syndrome, which often develops at a young age, in children and even infants, with female-male ratio of 5. Causes and pathogenesis of antiphospholipid syndrome are not fully clear. This problem is especially important for pregnant women. Almost a third of refractory pregnancy losses are associated with antiphospholipid antibodies formation. Main manifestations of this condition include thrombotic events during pregnancy and the postpartum period, including cerebral pathology in both mother and child. Central nervous system damage in this condition may have both ischemic (cerebrovascular accident) and nonischemic (primary immune-mediated damage of the nervous system) genesis. The variety of neurological disorders associated with antiphospholipid syndrome is very wide, from cerebrovascular disorders, migraine and migrainous headaches to chorea and seizures. Headaches are the most common reason for pregnant women to seek neurologic help. Pregnancy associated with high titers of antiphospholipid antibodies often end as early gestation stage stillbirth. Children born to mothers with antiphospholipid syndrome in 20% of cases develop neurological symptoms of ischemic and non-ischemic origin. Thus, antiphospholipid syndrome requires special attention for early and timely diagnosis, especially in women planning pregnancy and in pregnant women for the preventing serious complications, both in mother and fetus.