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Final Program


Final Program

1562 - When Clotting Turns Catastrophic: A Case Study of Ischemic Strokes In A Patient With Antiphospholipid Syndrome

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • Benjamin W. Cooper, DO

    Resident Physician
    Mercy Hospital
    Long Island City, New York, United States

  • BC

    Ben A. Cruci, DO

    Resident Physician
    Mercy Hospital
    Rockville Centre, New York, United States

    • Co-Author(s)

  • SA

    Shuchi Amin, MSc

    Medical Student
    Touro College of Osteopathic Medicine - New York
    Floral Park, New York, United States

  • IG

    Ireny Gobran-Sidhom, MBBS

    Medical Student
    New York Institute of Technology Old Westbury
    Jericho, New York, United States

  • LS

    Lauren Stimler-Levy, MD

    Attending Physician
    Mercy Hospital
    Rockville Centre, New York, United States

Case Diagnosis: Ischemic stroke secondary to Antiphospholipid Syndrome

Case Description: A 62 year old female with a past medical history of hypertension presented with right sided hemiplegia and aphasia. Imaging revealed an acute ischemic stroke of her left basal ganglia, which was followed by the evolution of bilateral ischemic strokes during her hospitalization and rehabilitation stay. Laboratory studies confirmed elevated antiphospholipid antibodies, and she was given the diagnosed with Antiphospholipid Syndrome (APS). The patient’s clinical course was further complicated by persistent fevers and a deterioration of her neurological status. Treatment included plasmapheresis, intravenous immunoglobulin (IVIG), and anticoagulation therapy. A rehabilitation interdisciplinary team of Physiatry, Neurology, Speech Language Pathology, Physical Therapy and Occupational Therapy treated her neurologic condition.

Discussions:

APS is a rare, multisystem autoimmune disorder that is associated with recurrent thromboembolic events, including stroke. This case highlights the complexity of APS. In this case, the combination of neurological deficits, persistent fevers, and laboratory findings were consistent with the diagnosis of catastrophic antiphospholipid syndrome (CAPS). CAPS is a rare, life-threatening form of APS characterized by severe thrombotic complications that affect multiple organs. The most commonly affected organs are the kidneys (74%), brain (56%), lungs (55%). An index for assessing the affected organ systems in APS may be utilized, Damage Index for Antiphospholipid Syndrome (DIAPS), which covers 10 organ systems and over 30 clinical problems. The primary organ systems assessed include the peripheral vascular, nervous, pulmonary, cardiac, ocular, renal, musculoskeletal, integumentary, gastrointestinal, and endocrine.

Conclusions:

This case underscores the importance of recognizing APS as a potential underlying cause of ischemic stroke, especially in patients with unusual clinical presentations. Early diagnosis and aggressive treatment are critical to preventing progression to catastrophic APS. This case adds to the limited number of cases concerning APS and stroke evolution and is interesting given its rarity seen in the medical field.