Factors that predict antiphospholipid immunoreactivity in young people with transient focal neurological events.

OBJECTIVE: To determine if clinical or radiological features in young people with transient focal neurological events may be used to predict the presence of antiphospholipid antibodies (aPL).

DESIGN: A combined retrospective and prospective study of young people with transient focal neurological events. Likelihood ratios and confidence intervals were calculated for the proportions; logistic regression analysis was performed to determine features predictive of aPL immunoreactivity.

SETTING: A referral hospital and adjacent outpatient clinic.

PATIENTS: Sixty-eight patients with one or more transient focal neurological events were screened for aPL. Forty-seven patients were obtained retrospectively from medical record review of every outpatient personally seen by two of us (G.E.T. and S.R.L.) during a 4.5-year period. Twenty-one patients were prospectively added prior to retrospective analysis. Patients older than 50 years or those with multiple sclerosis or epilepsy were excluded. Five patients fulfilling study criteria were excluded because aPL assay results were unavailable.

MAIN OUTCOME MEASURES: Transient neurological symptoms, stroke risk factors, occurrence of cerebral or ocular infarct or death, headache history, and serological and radiological studies were systematically obtained.

RESULTS: There were 29 aPL-positive patients compared with 39 aPL-negative ones. Features that distinguished the aPL-positive group included more common monocular visual symptoms (38% vs 15%, P = .03), hemisensory symptoms (76% vs 41%, P = .004), and systemic lupus erythematosus (14% vs 0%, P = .03) and less common binocular visual symptoms (28% vs 51%, P = .05), accompanying headache (66% vs 87%, P = .03), and personal (48% vs 74%, P = .03) and family (29% vs 61%, P = .01) history of migraine. No differences were noted between the groups for age, gender, stroke risk factor profile, and radiological features. In a logistic regression analysis, the estimated odds ratio for aPL positivity in patients with monocular visual disturbance, hemisensory symptoms, and no family history of migraine were 5.3, 7.5, and 3.0, respectively, when controlling for the other variables.

CONCLUSIONS: Several clinical features of transient focal neurological events in aPL-positive patients distinguish these individuals from their aPL-negative cohort. Amaurosis fugax, unilateral paresthesias, and no family history of migraine may predict aPL positivity in young persons with transient focal neurological deficits.