A case of massive aortic thrombosis with catastrophic cerebrovascular embolization and infarction

Abstract

Introduction: Antiphospholipid syndrome (APS) is the most common type of acquired thrombophilia. Lupus anticoagulant (LA) is more commonly associated with venous than with arterial thrombosis and accounts for 6–8% of thrombotic events. Case Report: A 50­year­ old African­American male presented to the emergency department with right sided hemiparesis, facial droop and impaired speech. First symptoms were noted about 10–12 hours before presentation to the emergency department. During two weeks preceding admission, patient experienced several transient episodes of similar neurological deficits. Computed tomography (CT) scan of brain done on admission showed ischemic stroke involving the area of distribution of the left middle cerebral artery. The CT angiography of brain revealed a large thrombus in the aortic arch, left common carotid and internal carotid artery. Laboratory studies were positive for lupus anticoagulant. Serial brain CT scan demonstrated increasing brain edema and midline shift eventually leading to transtentorial herniation. Several days after admission, neurological examination revealed loss of brain stem reflexes. Conclusion: Antiphosphotipid syndrome (APS) is the most common type of acquired thrombophilia. Lupus anticoagulant is mainly associated with venous thrombosis and accounts for 6–8% of thrombotic events in otherwise healthy patients. Prompt diagnosis and treatment, with long­term anticoagulation for survivors is crucial. The most common site of arterial thrombosis in APS is central nervous system, presenting with stroke and transient ischemic attacks in 50% of the cases. Patients with diagnosed APS and prior thrombosis have high risk for recurrent events. Due to this fact some authors postulate lifelong anticoagulation therapy.