Central Nervous System (CNS) Involvement in Antiphospholipid (Hughes) Syndrome – Prof Graham Hughes

Posted on: April 20, 2018
Last Updated: May 29, 2020

Professor Graham Hughes is a Consultant Rheumatologist and the founder and editor of the international journal ‘LUPUS,’ and Head of London Lupus Centre. In 1983 he described the clotting disorder now known as Hughes Syndrome for which he received the World Rheumatology (ILAR) Research Prize in 1993.

Author Quotes

Migraine, next to memory loss, is for me the number one feature of Hughes Syndrome.

 I think that APS is a missing link, maybe the missing link, between migraine and the risk of stroke.

Summary

Introducing the clinical features of CNS involvement in Hughes Syndrome he discusses the relevance of teenage migraines in later years, and how pregnant women with Lupus treated for thrombosis with heparin report a considerable reduction in migraines. Learn more about the neuropsychiatry of migraines.

Is APS the missing link between migraine and stroke? Considering the topic of young people with stroke, he highlights the importance of looking for antiphospholipid antibodies and why it is of economic and social importance.

He explains why the syndrome involves the brain.

He considers the question of why some patients are wrongly labeled with multiple sclerosis – and when histology reveals micro-thrombosis rather than inflammation, should this be treated with anticoagulants rather than steroids? Learn more about white matter hyperintensities in the brain.

 

Livedo reticularis (below) may be an important clinical sign.

 

Professor Hughes ends this short video with a presentation of features of the brain: movement disorders, myelopathy, and memory loss and a discussion of current and possible treatments.

Take-home Messages

  • Antiphospholipid Syndrome may be a missing link between migraine and stroke
  • Movement disorders, myelopathy, and memory loss are important indicators in Hughes Syndrome
  • Anticoagulants may be more relevant than steroids in treating Lupus.

Learn more

  1. Antiphospholipid Syndrome (APS) Case Files (Stroke and Thrombosis) By Prof Graham Hughes
  2. Antiphospholipid Syndrome (APS) Case Files (Gut, Tinnitus, and Migraine) – Prof Graham Hughes
  3. Antiphospholipid Syndrome (APS): The Clinical Experience – Dr. Graham Hughes
  4. Antiphospholipid Syndrome: 30 Years On – Dr. Graham Hughes
  5. Antiphospholipid Syndrome (APS) Case Files (Stillbirths and Epilepsy) By Prof Graham Hughes
  6. Clues to the Diagnosis of Antiphospholipid Syndrome – Prof Graham Hughes
  7. Neuropsychiatric Lupus and The Curious Case of Molly – What Does This Case Teach Us? – Prof Hughes
  8. Pathogenesis of Neuropsychiatric Systemic Lupus Erythematosus – Prof Graham Hughes
  9. What is Lupus? – Prof Graham Hughes
  10. Prof Graham Hughes Introduces You To The World of Lupus and Antiphospholipid Syndrome – Prof Graham Hughes
  11. APS and CNS Lupus: Anticoagulation Treatment By Prof Graham Hughes
  12. Neuropsychiatric Manifestations in APS By Prof Graham Hughes

Quiz


References

  1. Sanna G, Bertolaccini ML, Cuadrado MJ, Khamashta MA, Hughes GR. Central nervous system involvement in the antiphospholipid (Hughes) syndrome. Rheumatology (Oxford). 2003;42(2):200-213.
  2. Goldberg LD. The cost of migraine and its treatment. Am J Manag Care. 2005;11(2 Suppl): S62- 67.
  3. Diener HC, Kurth T. Is migraine a risk factor for stroke? Neurology. 2005;64(9):1496-1497.
  4. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain. 2005;128(Pt 9):2068-2077.
  5. Szmyrka-Kaczmarek M, Pokryszko-Dragan A, Pawlik B, et al. Antinuclear and antiphospholipid antibodies in patients with multiple sclerosis. Lupus. 2012;21(4):412-420.