2020 Volume 42 Issue 5 Pages 400-405
A 40-year-old male presented with diplopia and hospitalized with pontine infarction. Because he had thrombocyteopenia and prolonged activated partial thromboplastin time (APTT), we suspected the complication of antiphospholipid syndrome (APS). As a result of investigation, several antiphospholipid antibodies were all positive and thus the diagnosis of APS was confirmed. We initiated warfarin administration to prevent recurrence of infarction. Nevertheless, he had motor aphasia and right hemiplegia 4 months after the first visit. Diffusion-weighted (DW) image of MRI showed a new infarction in the left basal ganglia, and MRA showed an occlusion of the left middle cerebral artery. We deduced that intracranial artery lesion worsened due to the progression of APS, and added hydroxychloroquine to warfarin. One month later from discharge, DW-MRI showed a new asymptomatic infarction in the left thalamus, and MRA showed a stenosis at P1 segment of the left posterior cerebral artery. We added clopidogrel for 2 months, and the stenosis improved over time and he did well without recurrence. Drug treatments other than anticoagulation may be useful for prevention of recurrent brain infarction in APS patients.
