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lupus anticoagulant is not ideal, since most patients with the anticoagulant do not have lupus and the antibody has a procoagulant, not anticoagulant, property in vivo Nonetheless, the main laboratory feature of the illness is a prolonged partial thromboplastin time Further testing for antiphospholipid antibody consists of detection of both lupus anticoagulant and anticardiolipin antibody; there is a partial overlap between these 80 percent of patients with lupus anticoagulant have anticardiolipin antibody but fewer than 50 percent of those with anticardiolipin antibody have lupus anticoagulant The principal antigen involved is in fact not phospholipid but 2-glycoprotein 1, a protein that binds to phospholipid The titer of antibody correlates with the risk of thrombosis and smoking; pregnancy and the use of oral contraceptives raise the risk further There may be an increased incidence of migraine but this has been disputed The most frequent neurologic abnormality is a TIA, usually taking the form of amaurosis fugax (transient monocular blindness), with or without retinal arteriolar or venous occlusion (Digre et al) Stroke-like phenomena are more frequent in patients who also have migraine, hyperlipidemia, and antinuclear antibodies and in those who smoke or take birth control pills Almost one-third of the 48 patients reported by Levine and associates had thrombocytopenia and 23 percent had a false-positive VDRL test Some of the phospholipids with which the antibodies react are shared with clotting factors, particularly prothrombin and annexin, as well as with the lupus anticoagulant (a cardiolipin-glycoprotein complex) These antibodies are circulating serum polyclonal immunoglobulins (IgG, IgM, IgA) The vascular lesions are mainly in the cerebral white matter and are infarcts, seen well with MRI Angiography reveals occlusions of arteries at unusual sites (Brey et al) The mechanism of stroke is not entirely clear and may derive from emboli originating on mitral valve lea ets similar to nonbacterial thrombotic endocarditis; alternatively, and more likely in our view, there is a nonin ammatory in situ thrombosis of medium-sized cerebral vessels, as suggested by the limited pathologic material studied by Briley and colleagues These circulating antibodies may also cause a syndrome of transient bilateral choreal or hemichorea; some patients have an additional slight hemiparesis or other subtle focal signs Almost all of the affected patients we have seen have been women with thrombocytopenia, some of whom probably had systemic lupus, at least on the grounds of laboratory studies (see Cevera et al) A direct connection of the choreic syndrome to the antibodies, comparable to what is proposed in Sydenham chorea, may be valid but at the moment is unproven Some cases display microinfarctions in the basal ganglia, perhaps on the basis of valvular vegetations The syndrome may be precipitated in these patients by the introduction of estrogen-containing birth control pills and is improved, usually promptly, by corticosteroids or antiplatelet agents The Sneddon syndrome consists of deep blue-red lesions of livedo reticularis and livedo racemosa in association with multiple strokes; 126 cases had been reported up to 1992 Most but not all patients have high titers of antiphospholipid antibodies Although the skin lesions show a nonin ammatory vasculopathy with intimal thickening, the pathology of the occlusive disease has not been adequately studied In a report of 17 such patients by Stockhammer and coworkers, 8 had strokes and MRI showed lesions in 16 of 17 patients The age of patients with strokes was 30 to 35 years, hence this condition must always be considered in young adults with cerebrovascular disease Many of the lesions on MRI were small, deep, and multiple Although there is a tendency for strokes to recur,. java upc-a Generate UPC-A barcode in Java class using Java UPC-A ...
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UPC-A barcode generator can print UPC-A and saved it as GIF and JPEG images using Java class library. Generated UPC-A barcode images can be displayed ...
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