The Significance of Antiphospholipid Antibodies in Ischaemic Brain Disease in Adults Sudanese Patients

Abstract

This study is a hospital based, case controlled, cross-sectional study, carried out during the period from July 2003 till January 2005 in ElShaab and Khartoum Teaching Hospitals, to assess the prevalence of Antiphospholipid antibodies (APLAs) in ischaemic brain disease (IBD) patients and to find out their special features. 160 individuals were studied; 89 with IBD (48 females and 41 males), 35 with other diseases (13 females, 22 males), 36 healthy control (18 females, 18 males). Patients were studied using a simple direct, standardized questionnaire including, history, physical examination and investigations. All individual were tested for APLAs, IBD patients were examined by CT brain, ESR and platelets, lipid profile and blood sugars. Antinuclear factor (ANF) was done in 24 patients, anti double stranded DNA in 18, partial thrombo blastin time (PTT) in 16 and VDRL in 14 patients. Echocardiography was done in eight patients, echocardiography and carotid Doppler’s in six patients. Follow-up CT scan brain six weeks following stroke was done in four APLAs +ve patients. APLAs +ve patients with IBD showed a female : males ratio of 2 : 1.5 and increased incidence in the age group 20-29 years. APLAs +ve patients at presentation tend to have more headache and fits but have less disturbance of consciousness, speech disturbance or motor weakness compared to those who were APLA –ve. They were also found to have more frequent history of DVT, migraine and abortion. APLAs were found to be strongly associated with elevated ESR and low platelets, +ve VDRL, carotid stenosis, ANF and prolonged PTT. Follow-up CT brain six weeks following stroke was done in four patients and found to return to normal in three of them. The study demonstrated higher local incidence of APLAs in IBD than that reported worldwide, and they tends to occur more commonly in young females with IBD, suggesting a possible causal relationship. The study also suggested a better prognosis in stroke patients for motor weakness and CT changes.