Sneddon and antiphospholipid antibody syndromes causing bilateral thalamic infarction

Area of Science:

• Neurology
• Pediatric Neurology
• Vascular Neurology

Background:

• Sneddon syndrome is a rare, non-inflammatory occlusive hydrocephalus characterized by recurrent ischemic strokes and livedo reticularis.
• Antiphospholipid antibody syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis.
• Pediatric stroke is a significant cause of long-term disability, with diverse underlying etiologies.

Observation:

• A pediatric patient presented with hypersomnolence, mood disturbance, and amnesia, indicative of bilateral thalamic infarction.
• Diagnostic workup revealed the co-occurrence of Sneddon syndrome and antiphospholipid antibody syndrome as the cause of the stroke.
• This case highlights an unusual presentation of these conditions in a pediatric patient.

Findings:

• Bilateral thalamic infarction in a child is a rare manifestation of combined Sneddon and antiphospholipid antibody syndromes.
• The clinical presentation included neurological deficits consistent with thalamic injury.
• Laboratory evaluations confirmed the presence of antiphospholipid antibodies and features of Sneddon syndrome.

Implications:

• This case underscores the importance of considering Sneddon and antiphospholipid antibody syndromes in pediatric patients with unexplained ischemic strokes, particularly those with thalamic involvement.
• Treatment strategies, including long-term, high-intensity warfarin anticoagulation, may be extrapolated from adult management protocols for APS and related thrombotic disorders.
• Further research is warranted to elucidate the specific pathophysiology and optimize management of Sneddon syndrome and APS in the pediatric population.