SIXTH AND SEVENTH NERVES PALSY IN A PATIENT WITH LABORATORY CRITERIA OF ANTIPHOSPHOLIPID SYNDROME: AN ATYPICAL CLINICAL PRESENTATION

The antiphospholipid syndrome (APS) is an autoimmune disease defined by clinical (generally thrombotic disorders due to hypercoagulability) and laboratory manifestations (anticardiolipin antibodies of IgG and/or IgM isotype and lupus anticoagulant). The clinical syndrome causes coronary heart disease, abortion, venous thrombosis, stroke and ischemic presentations in other organs. Atypical presentations, including movement disorders and fascicular third nerve palsy, were reported. The main goal of the article is to report a patient with sixth and seventh cranial nerves palsy related to APS.

Case Report: A 66-year-old hypertense female presented sudden left hemicranial headache associated with horizontal diplopia and dizziness. The patient was discharged with diagnosis of idiopathic palsy of the left sixth nerve in the context of chronic hypertension. Two months later the patient was admitted due to worsening of the left hemicranial headache and left facial peripheral paresis. The brain CT scan and MRI studies were normal. An exhaustive analysis of blood and cerebrospinal fluid was performed, and the only pathologic findings were lupus anticoagulant and IgM anti-cardiolipin and anti-B2 glycoprotein antibodies. The patient was treated with 150 mg of acetylsalicylic acid and after 5 months showed an incomplete recovery of the seventh nerve lesion. The paraclinical study was repeated, showing IgM anti-B2 glycoprotein antibody raised. During follow-up a diagnosis of coronary heart disease was done by the Cardiologist.

Discussion: The reported patient met laboratory criteria of APS, showed cardiac thrombotic disease, and compressive, infiltrative, infectious or inflammatory causes of cranial multineuritis were ruled out. The results may suggest the presence of an ischemic microvascular occlusion of vasa nervorum related to APS as the mechanism of disease.