The left middle cerebral artery and anterior cerebral vasculature were unaffected. Results of an electroencephalogram were nonfocal. Antithrombin III activity was normal. In view of the medical history, angiographic findings, and abnormal RVVT result, a diagnosis of antiphospholipid syndrome was made. Anticonvulsants were gradually discontinued, and no further seizure activity has occurred.
Stroke is often the initial manifestation and is the best described.
Echocardiographic evidence5 of mitral valvular lesions, mitral valve prolapse, mitral regurgitation, and aortic valvular abnormalities has been implicated as sources for cerebrovascular events. However, many patients show no evidence of cardiac pathology following cerebrovascular events, suggesting the role of in situ thrombosis as a causative mechanism. Arterial ischemic events were responsible for most strokes, with hemorrhage being distinctly uncommon. In this patient, a hemorrhagic infarction was most likely due to necrosis after an intravascular thrombus. It is possible that antiphospholipid syndrome is one underlying cause of idiopathic or embolic cerebrovascular accidents in this population.