Antiphospholipid Antibody Syndrome Presenting with Hemichorea

Yezenash Ayalew,Fazlihakim Khattak

doi:10.1155/2012/471543

Abstract

A 25-year-old Bangladeshi lady presented to neurology with a three-month history of involuntary movements of her right arm, associated with loss of power. There was progression to the right leg, and she subsequently developed episodes of slurred speech and blurred vision. At the time of presentation, she was 12 weeks pregnant and the symptoms were reported to have started at conception. Past medical history was unremarkable apart from one first trimester miscarriage and there was no significant family history suggestive of a hereditary neurological condition. MRI of the head revealed no abnormalities but serology showed positive antinuclear antibodies (ANAs) at a titre of 1/400. Further investigations revealed strongly positive anticardiolipin antibodies (>120) and positive lupus anticoagulant antibodies. The patient had a second miscarriage at 19 weeks gestation strengthening the possibility that the chorea was related to antiphospholipid antibody syndrome and she was started on a reducing dose of Prednisolone 40 mg daily and aspirin 300 mg daily. Six months later, she had complete resolution of neurological symptoms. There are several reports of chorea as a feature of antiphospholipid syndrome, but no clear consensus on underlying pathophysiology.

Highlights

We would like to report the case of a 25-year-old Bangladeshi lady who was referred to neurology with a three-month history of frequent, involuntary movements of her right arm, with associated loss of power
Antiphospholipid antibody syndrome (APS) is characterised by recurrent pregnancy loss and thromboembolism due to a procoagulant state conferred by the presence of antiphospholipid antibodies
Involvement of the central nervous system most often presents as a stroke or transient ischaemic attack; chorea is rare in both primary and secondary APS

Summary

Yezenash Ayalew and Fazlihakim Khattak

A 25-year-old Bangladeshi lady presented to neurology with a three-month history of involuntary movements of her right arm, associated with loss of power. At the time of presentation, she was 12 weeks pregnant and the symptoms were reported to have started at conception. The patient had a second miscarriage at 19 weeks gestation strengthening the possibility that the chorea was related to antiphospholipid antibody syndrome and she was started on a reducing dose of Prednisolone 40 mg daily and aspirin 300 mg daily. Six months later, she had complete resolution of neurological symptoms.

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