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allied
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NEUROSCIENCE AND NEUROLOGICAL DISORDERS
PSYCHIATRY AND PSYCHOLOGICAL DISORDERS
&
International Conference on
International Conference on
J u n e 2 8 - 2 9 , 2 0 1 8 | D u b l i n , I r e l a n d
Journal of Neurology and Neurorehabilitation Research
|
Volume 3
Page 28
Note:
Joint Event on
A
29-year-old African American lady presented to the ER with sudden onset
right UE weakness and numbness, right LE drift with an NIHSS of three. She
then suffered right eye blindness with an NIHSS of five. She has a past medical
history of systemic lupus. She qualified to receive IV TPA, the platelet count
was pending. The patient’s right weakness and right eye blindness improved
and her NIHSS improved to one manifesting as mild hand drift. At the very
end of the IV TPA infusion the patient informed us that she is on lovenox 1
mg/Kg body wt Q12Hr despite initially denying being on anticoagulation.
All medications to reverse a post-TPA bleed were ordered as standby and
the patient was closely monitored. Few hours after the IV TPA infusion she
suffered right lower extremity symptoms or embolization. A diagnosis of a
thrombotic storm versus Heparin-induced Thrombocytopenia versus DIC
was contemplated. The platelet count was unavailable due to clumping. The
Hematology consultant advised starting a direct thrombin inhibitor: lepirudin
and the Vascular Surgery performed a successful right femoral artery-popliteal
bypass and right anterior tibial embolectomy. The patient’s labs showed a
normal Fibrinogen level, a D-dimer and no schistocytes indicating no DIC. The
SRA test for Heparin induced thrombocytopenia was negative. The diagnosis
was CAPS which represents the perfect stormwith cytokine-induced activation
of vascular endothelium and changes in coagulation factors and platelets.
Platelets count was 174,000. The patient continued to improve, the stroke was
punctate.
Biography
Mervat Wahba is an Associate Professor of Neu-
rology UTHSC since July 1st, 2012 to current. She
served as an Assistant Professor of Neurology
UTHSC since February 1st, 2006 to June 30th,
2012. She is the Fellowship Director of Vascular
Neurology, from September 1st, 2010 to October
5th, 2015. She is the Medical Director of Compre-
hensive Stroke Canter. She is also the Methodist
System Medical Director since September 1st,
2010 to March 2nd, 2014. She has been work-
ing as a Neurology Clerkship Director since May
2008 till today.
mwahba@uthsc.eduCATASTROPHIC ANTIPHOSPHOLIPID
ANTIBODIES SYNDROME
Mervat Wahba
University of Tennessee, USA
Mervat Wahba, J Neurol Neurorehabil Res 2018, Volume 3