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. 1987 Aug;46(8):605–611. doi: 10.1136/ard.46.8.605

Recurrent stroke and multi-infarct dementia in systemic lupus erythematosus: association with antiphospholipid antibodies.

R A Asherson 1, D Mercey 1, G Phillips 1, N Sheehan 1, A E Gharavi 1, E N Harris 1, G R Hughes 1
PMCID: PMC1002208  PMID: 3116954

Abstract

Four patients with recurrent stroke and multi-infarct dementia are presented in whom the dementia was progressive and severe. Three of the patients developed the dementia during the course of an illness which was punctuated by repeated episodes of cerebral infarction demonstrated by computed tomographic (CT) scans. The fourth patient presented with an illness dominated by progressive and deteriorating higher mental functions, which culminated in a major stroke 18 months later. Three patients fulfilled the American Rheumatism Association (ARA) criteria for the classification of systemic lupus erythematosus, the fourth had a 'lupus-like' disease. All had livedo reticularis, severe migraines, and also demonstrated antibodies to phospholipids. All four patients suffered deep vein thromboses.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bennett R., Hughes G. R., Bywaters E. G., Holt P. J. Neuropsychiatric problems in systemic lupus erythematosus. Br Med J. 1972 Nov 11;4(5836):342–345. doi: 10.1136/bmj.4.5836.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beurey J., Weber M., Edelson F., Thomas I., Eich D. Livedo reticularis et accidents vasculaires cérébraux. Ann Dermatol Venereol. 1984;111(1):25–29. [PubMed] [Google Scholar]
  3. Bouchez B., Arnott G., Hatron P. Y., Wattel A., Devulder B. Chorée et lupus érythémateux disséminé avec anticoagulant circulant. Trois cas. Rev Neurol (Paris) 1985;141(8-9):571–577. [PubMed] [Google Scholar]
  4. Derksen R. H., Bouma B. N., Kater L. The association between the lupus anticoagulant and cerebral infarction in systemic lupus erythematosus. Scand J Rheumatol. 1986;15(2):179–184. doi: 10.3109/03009748609102086. [DOI] [PubMed] [Google Scholar]
  5. Ellis S. G., Verity M. A. Central nervous system involvement in systemic lupus erythematosus: a review of neuropathologic findings in 57 cases, 1955--1977. Semin Arthritis Rheum. 1979 Feb;8(3):212–221. doi: 10.1016/s0049-0172(79)80009-8. [DOI] [PubMed] [Google Scholar]
  6. GOLDEN R. L. Livedo reticularis in systemic lupus erythematosus. Arch Dermatol. 1963 Mar;87:299–301. doi: 10.1001/archderm.1963.01590150015002. [DOI] [PubMed] [Google Scholar]
  7. Gharavi A. E., Harris E. N., Asherson R. A., Hughes G. R. Anticardiolipin antibodies: isotype distribution and phospholipid specificity. Ann Rheum Dis. 1987 Jan;46(1):1–6. doi: 10.1136/ard.46.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Harris E. N., Englert H., Derve G., Hughes G. R., Gharavi A. Antiphospholipid antibodies in acute Guillain-Barré syndrome. Lancet. 1983 Dec 10;2(8363):1361–1362. doi: 10.1016/s0140-6736(83)91113-3. [DOI] [PubMed] [Google Scholar]
  9. Harris E. N., Gharavi A. E., Asherson R. A., Boey M. L., Hughes G. R. Cerebral infarction in systemic lupus: association with anticardiolipin antibodies. Clin Exp Rheumatol. 1984 Jan-Mar;2(1):47–51. [PubMed] [Google Scholar]
  10. Hart R. G., Miller V. T., Coull B. M., Bril V. Cerebral infarction associated with lupus anticoagulants--preliminary report. Stroke. 1984 Jan-Feb;15(1):114–118. doi: 10.1161/01.str.15.1.114. [DOI] [PubMed] [Google Scholar]
  11. Hughes G. R. The Prosser-White oration 1983. Connective tissue disease and the skin. Clin Exp Dermatol. 1984 Nov;9(6):535–544. doi: 10.1111/j.1365-2230.1984.tb00856.x. [DOI] [PubMed] [Google Scholar]
  12. Hughes G. R. The anticardiolipin syndrome. Clin Exp Rheumatol. 1985 Oct-Dec;3(4):285–286. [PubMed] [Google Scholar]
  13. Johnson R. T., Richardson E. P. The neurological manifestations of systemic lupus erythematosus. Medicine (Baltimore) 1968 Jul;47(4):337–369. doi: 10.1097/00005792-196807000-00002. [DOI] [PubMed] [Google Scholar]
  14. Jonas J., Kölble K., Völcker H. E., Kalden J. R. Central retinal artery occlusion in Sneddon's disease associated with antiphospholipid antibodies. Am J Ophthalmol. 1986 Jul 15;102(1):37–40. doi: 10.1016/0002-9394(86)90206-0. [DOI] [PubMed] [Google Scholar]
  15. Landi G., Calloni M. V., Grazia Sabbadini M., Mannuccio Mannucci P., Candelise L. Recurrent ischemic attacks in two young adults with lupus anticoagulant. Stroke. 1983 May-Jun;14(3):377–379. doi: 10.1161/01.str.14.3.377. [DOI] [PubMed] [Google Scholar]
  16. Lechner K., Pabinger-Fasching I. Lupus anticoagulants and thrombosis. A study of 25 cases and review of the literature. Haemostasis. 1985;15(4):254–262. doi: 10.1159/000215157. [DOI] [PubMed] [Google Scholar]
  17. Lockshin M. D., Druzin M. L., Goei S., Qamar T., Magid M. S., Jovanovic L., Ferenc M. Antibody to cardiolipin as a predictor of fetal distress or death in pregnant patients with systemic lupus erythematosus. N Engl J Med. 1985 Jul 18;313(3):152–156. doi: 10.1056/NEJM198507183130304. [DOI] [PubMed] [Google Scholar]
  18. Lubach D., Stamm T. Generalized racemose livedo and neurological lesions. Br J Dermatol. 1983 Apr;108(4):501–501. doi: 10.1111/j.1365-2133.1983.tb04605.x. [DOI] [PubMed] [Google Scholar]
  19. Lubach D., Stamm T. Neurologische Veränderungen bei Livedo racemosa generalisata (Ehrmann). Kasuistik und Literaturübersicht. Hautarzt. 1981 May;32(5):245–248. [PubMed] [Google Scholar]
  20. Lubbe W. F., Butler W. S., Palmer S. J., Liggins G. C. Lupus anticoagulant in pregnancy. Br J Obstet Gynaecol. 1984 Apr;91(4):357–363. doi: 10.1111/j.1471-0528.1984.tb05923.x. [DOI] [PubMed] [Google Scholar]
  21. Marsch W. C., Muckelmann R. Generalized racemose livedo with cerebrovascular lesions (Sneddon syndrome): an occlusive arteriolopathy due to proliferation and migration of medial smooth muscle cells. Br J Dermatol. 1985 Jun;112(6):703–708. doi: 10.1111/j.1365-2133.1985.tb02341.x. [DOI] [PubMed] [Google Scholar]
  22. Oppenheimer S., Hoffbrand B. I. Optic neuritis and myelopathy in systemic lupus erythematosus. Can J Neurol Sci. 1986 May;13(2):129–132. doi: 10.1017/s0317167100036064. [DOI] [PubMed] [Google Scholar]
  23. PROCTOR R. R., RAPAPORT S. I. The partial thromboplastin time with kaolin. A simple screening test for first stage plasma clotting factor deficiencies. Am J Clin Pathol. 1961 Sep;36:212–219. doi: 10.1093/ajcp/36.3.212. [DOI] [PubMed] [Google Scholar]
  24. Pinol Aquadé J., Ferrándiz C., Ferrer Roca O., Ingelmo M. Livedo reticularis y accidentes cerebro-vasculares. Med Cutan Ibero Lat Am. 1975;3(4):257–265. [PubMed] [Google Scholar]
  25. Quimby S. R., Perry H. O. Livedo reticularis and cerebrovascular accidents. J Am Acad Dermatol. 1980 Oct;3(4):377–383. doi: 10.1016/s0190-9622(80)80331-8. [DOI] [PubMed] [Google Scholar]
  26. Rebollo M., Val J. F., Garijo F., Quintana F., Berciano J. Livedo reticularis and cerebrovascular lesions (Sneddon's syndrome). Clinical, radiological and pathological features in eight cases. Brain. 1983 Dec;106(Pt 4):965–979. doi: 10.1093/brain/106.4.965. [DOI] [PubMed] [Google Scholar]
  27. Rumpl E., Rumpl H. Recurrent transient global amnesia in a case with cerebrovascular lesions and livedo reticularis (Sneddon Syndrome). J Neurol. 1979 Aug;221(2):127–131. doi: 10.1007/BF00313110. [DOI] [PubMed] [Google Scholar]
  28. SILVERSTEIN A. CEREBROVASCULAR ACCIDENTS AS THE INITIAL MAJOR MANIFESTATION OF LUPUS ERYTHEMATOSUS. N Y State J Med. 1963 Oct 15;63:2942–2948. [PubMed] [Google Scholar]
  29. SNEDDON I. B. CEREBRO-VASCULAR LESIONS AND LIVEDO RETICULARIS. Br J Dermatol. 1965 Apr;77:180–185. doi: 10.1111/j.1365-2133.1965.tb14628.x. [DOI] [PubMed] [Google Scholar]
  30. Stamm T., Schmidt R. C., Lubach D. Livedo racemosa generalisata (Ehrmann). Neurologische, neuroradiololgische und histologische Beobachtungen. Nervenarzt. 1982 Apr;53(4):211–218. [PubMed] [Google Scholar]
  31. Stephens W. P., Ferguson I. T. Livedo reticularis and cerebro-vascular disease. Postgrad Med J. 1982 Feb;58(676):70–73. doi: 10.1136/pgmj.58.676.70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
  33. Thomas D. J., Kirby J. D., Britton K. E., Galton D. J. Livedo reticularis and neurological lesions. Br J Dermatol. 1982 Jun;106(6):711–712. doi: 10.1111/j.1365-2133.1982.tb11688.x. [DOI] [PubMed] [Google Scholar]

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