Clinical features that may predict the presence of antiphospholipid antibodies (aPL) in young patients with transient focal neurological events were determined in a study at the Henry Ford Hospital, Detroit, MI. Among 68 patients 29 were aPL-positive and 39 aPL-negative. The aPl-positive group was distinguished by a greater frequency of monocular visual symptoms, hemisensory symptoms, and systemic lupus erythematosus and less common binocular visual symptoms, accompanying headache, and personal and family history of migraine. Amaurosis fugax, unilateral paresthesias, and absence of a family history of migraine may predict aPL positivity (lupus anticoagulants and/or anticardiolipin antibodies) in young persons with transient focal neurologic deficits. [1]
COMMENT. Cerebral infarction, transient ischemic attacks (TIAs), and migraine have been associated with aPL positivity. Immune-mediated thrombotic tendency conferred by the antibodies has been postulated. Monocular visual loss, hemiparesthesia, and no family history of migraine in young patients with transient focal neurological events should prompt examination for aPL antibodies and further determination of risk of stroke.