Abstract Details

Title Phantosmia associated with Anti-Phospholipid Antibody Syndrome

Topic Autoimmune Neurology

Presentation(s) Autoimmune Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 099

Objective To describe a case of adult-onset seizures in the setting of anti-phospholipid antibody syndrome (APS).

Background Neurological involvement with APS can have a varied presentation. The reported prevalence of seizures in APS is about 3.2 to 10 percent. However, the prevalence of seizure-like activity associated with APS in the presence of systemic lupus erythematosus (SLE) may be higher than previously described. Besides ischemic lesions due to hypercoagulability, antibody-mediated immune pathology has been proposed as the cause of seizures. Certain ictal features like olfactory/gustatory hallucinations may direct to extra-temporal regions, e.g. insula, fronto-basal and orbital cortices.

Design/Methods Retrospective chart review and literature search.

Results 53-year-old male with history of recurrent sinusitis status post multiple sinus surgeries presented for neurological symptoms of experiencing abnormal smell. He describes it as smelling “salt water” that would last for less than a minute and roughly had around 10 spells a month. One spell was severe enough that he had a near fall in the shower and dropped to his knees with no recollection of the event. A routine electroencephalogram showed no abnormalities. He was worked up for transient ischemic attacks which revealed positive serum antiphospholipid antibodies, mainly lupus anticoagulant and anticardiolipin antibody which was persistently positive with repeat testing about 12 weeks later. MRI of the brain showed extensive hyperintensities in the supratentorial subcortical and deep white matter of bilateral cerebral hemispheres but no cortical lesions to suggest an ictal nidus. Treatment with anti-seizure medication (levetiracetam) resolved the olfactory aura spells. It was postulated that these spells of phantosmia (olfactory aura / hallucination) were a part of the seizure semiology caused by autoimmune mediated pathology in APS which resolved with treatment.

Conclusions

APS should be considered in the differentials for patients presenting with adult-onset seizures in the setting of SLE.

Authors/Disclosures
Alexis E. Brantley PRESENTER	Alexis Brantley has nothing to disclose.
Maryam Zulfiqar, MD	Dr. Zulfiqar has nothing to disclose.
Prashant Natteru, MBBS (Mayo Clinic Health System)	Dr. Natteru has nothing to disclose.
Shreyas Gangadhara, MD, FAAN (University of Mississippi Medical Center)	Dr. Gangadhara has nothing to disclose.

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