Rare Antiphospholipid Syndrome Caused Recurrent Strokes in 66-Year-Old Woman

Antiphospholipid syndrome is a known but rare cause of embolic ischemic stroke. While it is associated with up to 20% of strokes in individuals under 50, it is considered a very seldom cause of stroke in patients over 50, according to a case report published June 26, 2024, in the journal Brain Circulation.

Four strokes and mechanical thrombectomies in a 66-year-old patient

The patient, a 66-year-old white woman, experienced four embolic strokes involving large vessel occlusion within a two-year window. According to the report by Anatoli Anastasiadi et al., each of these events was treated with mechanical thrombectomy, which the authors describe as successful. Despite these interventions, the patient continued to suffer stroke recurrences.

Medical teams initially attributed the strokes to atrial fibrillation. Based on this diagnosis, the patient was treated with direct oral anticoagulants. However, this treatment regimen failed to prevent further embolic events, leading clinicians to investigate other etiologies for the recurrent strokes.

Diagnosis of primary APS via anti-beta 2-glycoprotein antibodies

The diagnosis of primary antiphospholipid syndrome was eventually reached after the patient presented with isolated anti-beta 2-glycoprotein antibodies. This finding shifted the treatment strategy away from the previously prescribed direct oral anticoagulants.

Following the initiation of Vitamin K antagonist therapy, the patient experienced no further strokes. The report identifies this specific case as an example of late-onset APS, which can present a significant diagnostic challenge in elderly patients where the syndrome is less commonly suspected.

Diagnostic imaging and clinical findings at Klinikum Stuttgart

The case was managed across multiple specialties at Klinikum Stuttgart, including the departments of Neurology, Nephrology, Cardiology, and Neuroradiology, with additional involvement from the Neurologische Klinik at the Medizinische Fakultät Mannheim, Universität Heidelberg.

• CT perfusion.

The authors conclude that for elderly patients experiencing recurrent embolic strokes despite the use of oral anticoagulation, late-onset APS should be considered as a rare but possible etiology.