Lupus anticoagulant and lacunar infarctions

Area of Science:

• Neurology
• Immunology
• Vascular Medicine

Background:

• Lupus anticoagulant (LA) is a prothrombotic condition, typically linked to venous and arterial thromboembolism.
• While hemorrhage is less common, LA's role in specific neurological events like lacunar infarction requires further investigation.

Observation:

• Two cases of basal ganglion lacunar infarction presenting with contralateral choreoathetosis were observed in patients with lupus anticoagulant.
• One patient had idiopathic LA and responded to antiplatelet therapy.
• The second patient had systemic lupus erythematosus with nephritis and was treated successfully with corticosteroids.

Findings:

• Lupus anticoagulant may contribute to small-vessel occlusion in the brain, specifically causing basal ganglion lacunar infarction.
• The mechanism may involve LA's effects on platelet prostacyclin pathways or cerebral vasculature.
• Clinical presentation included contralateral choreoathetosis secondary to the infarction.

Implications:

• These findings highlight a potential, albeit less common, neurological manifestation of lupus anticoagulant.
• Tailored therapeutic strategies, including antiplatelet agents and immunosuppressants, may be effective depending on the underlying etiology.
• Further research is warranted to elucidate the precise pathogenic mechanisms of LA in ischemic stroke.