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Yıl:2013; Cilt: 50; Sayı: 2>> Özet
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Nöropsikiyatri Arşivi; 2013;50(2):180-182
Otoantikorları Negatif Sneddon Sendromu: Olgu Sunumu ve Literatürün Gözden Geçirilmesi
E Arslan, AC Dirican, DH Ertem, Y Altunkaynak, S Baybaş, Y Özkan
Bakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Sneddon Sendromu ciltte livedo retikülaris ve tekrarlayan serebrovasküler ataklarla karakterize, otoimmün olduğu düşünülen ve nadir görülen bir hastalıktır. Tekrarlayan düşükler, nöbet, kognitif yetmezlik, hipertansiyon hastalıkta görülen diğer semptomlardır. 48 yaşında kadın hasta görme bozukluğu, sol taraf güçsüzlüğü şikayeti ile başvurdu. Özgeçmişinde hipertansiyon ve altı düşük, bir ölü doğum öyküsü mevcuttu. Fizik muayenesinde her iki üst ve alt ekstremitede mavi-mor renkli düzensiz sınırlı cilt lezyonları mevcuttu. Nörolojik muayenesinde sol homonim hemianopsi, her iki üst ekstremite distallerinde früst parezi ve derin tendon reflekslerinde canlılık saptandı. Beyin görüntülemesinde sağ oksipital subakut enfarkt, sol temporal, her iki serebellar ve sol frontal kronik enfarkt alanları ve periventriküler iskemik değişiklikler mevcuttu. Antikardiolipin antikorları ve lupus antikoagülanı negatif, fibrinojen, homosistein, protein-C, protein aktivitesi normal sınırlardaydı, faktör 5 Leiden mutasyonu saptanmadı, ANA 1/100 titrede pozitif idi. Nöropsikometrik testte orta derecede bellek bozukluğu vardı. Lezyonlu bölgeden yapılan cilt biyopsisinde Sneddon Sendromuyla uyumlu biyopsi bulguları saptandı. Özgeçmiş, klinik ve laboratuvar sonuçları ile Sneddon Sendromu tanısı düşünülen hastaya antiagregan tedavisi başlandı. Bu olgu sunumunda Sneddon Sendromunun tipik bulgularını gösteren ve otoantikorları negatif saptanan bir hastanın klinik göstergeleri, cilt biyopsisi ve nöroradyolojik bulgularının tartışılması ve tedavi yaklaşımımızın paylaşılması amaçlanmıştır.
Antiphospholipid-Antibody-Negative Sneddon's Syndrome: A Case Report and Review of the Literature
Sneddon's Syndrome is a systemic disease characterized by livedo reticularis and cerebrovascular lesions. Its clinical presentation varies widely and its etiology is still unknown. Other symptoms that can accompany are cognitive decline, epilepsy, headache, miscarriages and hypertension. A 48-year-old female with a history of hypertension, 6 miscarriages and one stillbirth presented to our clinic with acute left-sided weakness and vision loss. Physical examination showed blue-purple skin marks with irregular borders on her upper and lower extremities. The patient’s neurological examination revealed left homonymous hemianopia, mild hemiparesis of distal upper extremities and globally hyperactive deep tendon reflexes. Brain imaging confirmed a subacute right occipital infarct and showed chronic infarcts in the left frontal and temporal lobes, bilateral cerebellar infarctions and ischemic changes in the periventricular regions. Anticardiolipin antibodies and lupus anticoagulant were negative. Factor V Leiden mutation was not found, homocysteine, Protein S and protein C activity and fibrinogen levels were within the normal ranges. Titre of antinuclear antibodies (ANA) was over 1/100. Neuropsychological testing revealed mild memory difficulties. The skin biopsy was compatible with Sneddon’s syndrome. The patient was diagnosed with Sneddon's syndrome based on historical, clinical and laboratory findings and antiaggregant therapy was initiated. In this case report, we aimed to discuss clinical manifestations, pathological findings in the skin lesions and neuroradiological findings in a patient with antiphospholipid-antibody-negative Sneddon's syndrome and wanted to share our treatment approach.

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