Antiphospholipid Antibodies in Cerebrovascular Ischemia and Stroke in Childhood

Abstract

We report on eight children who suffered from cerebrovascular ischemia or stroke at the age of 2 or up to 11 years. Antiphospholipid antibodies (APLA) were detected in two cases during the ischemic event and in six cases during follow-up examinations (after six weeks or within a span of six years).

In two patients multiple stenoses of basal cerebral arteries were found; one of them suffered from moyamoya syndrome. The acute hemiplegia in one patient was linked to an asymptomatic mycoplasmal infection and APLA. In three cases, one of the parents was also APLA-positive. Seven patients were treated with acetylsalicylic acid, and in four cases immunoglobulin infusions were given. Transient ischemic attacks subsided after the child with the moyamoya syndrome received immunoglobulins. No effect of medication could be established in the other children.

The concept of the antiphospholipid syndrome is still evolving. As none of the common risk factors pertaining to strokes in adults apply to children, pediatric research may offer a suitable platform for specific investigations on the causal, pathogenetic role of APLA. We propose that all children suffering from stroke or transient ischemic attacks should be tested for APLA.

Abbreviations

ACA: anterior cerebral artery
APLA: antiphospholipid antibodies
ICA: internal carotid artery
LA: lupus anticoagulant
LE: lupus erythematosus
MCA: middle cerebral artery
MRI: magnetic resonance imaging
OD: optical density
TCCD: transcranial color duplex sonography
TIA: transient ischemic attacks

Key words

Antiphospholipid antibodies - Transient ischemic attacks - Acute hemiplegia - Moyamoya syndrome