warfarin and Parkinsonian-Disorders

Antiphospholipid syndrome (APS) is a cause of chronic thromboembolic pulmonary hypertension (CTEPH) and it is associated with an increased risk of postoperative neurological complications. We experienced a case of reversible parkinsonism after pulmonary endarterectomy (PEA) and subsequent multiple cerebral infarctions under standard anticoagulation therapy in a patient with CTEPH associated with APS. Strict management using a combination of antiplatelet and anticoagulation therapy should be considered in patients with a high titer of triple antiphospholipid antibodies in the perioperative period. We should be aware of the high risk of postoperative neurologic manifestations in patients with APS.

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Cerebral Infarction; Chronic Disease; Endarterectomy; Heparin; Humans; Hypertension, Pulmonary; Male; Parkinsonian Disorders; Postoperative Complications; Pyridines; Thiazoles; Treatment Outcome; Warfarin

Antiphospholipid syndrome (APS) is identified as the presence of antiphospholipid antibodies (aPLs) in patients with vascular thrombosis and/or pregnancy morbidity (including fetal death, premature birth and habitual abortion). Neurological manifestations in patients with APS are common, whereas movement disorders are rarely seen. We report an extremely rare case of APS presented with parkinsonism and review the literature to address the clinical profile and possible pathophysiologic mechanism of this disorder.

Topics: Adult; Anticoagulants; Antiparkinson Agents; Antiphospholipid Syndrome; Brain; Cerebral Arteries; Corpus Striatum; Dementia, Vascular; Female; Humans; Intracranial Thrombosis; Levodopa; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Parkinsonian Disorders; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Warfarin