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PURPOSE: The prevalence of the antiphospholipid syndrome was determined Prospectively in Patients presenting with stroke and transient ischemic attacks. An attempt was made to define a subset Of stroke patients at risk for this syndrome on the basis of their clinical features. PATIENTS AND METHODS. Fifty-one consecutive patients with stroke and transient ischemic attacks were Tests used for the laboratory diagnosis of the antiphospho]ipid syndrome included four phospholipid-dependent coagulation tests for detection of the lupus anticoagulant, and two enzyme-linked immunosorbent assays for antibodies to phospholipid. RESULTS: Three of 51 patients (6 %, 95 % confidence intervals 0% to 12.0%) had a lupus anticoagulant and the clinical features of the antiphospholipid syndrome. Seven patients had clinical features suggestive of the syndrome but negative laboratory test& Those patients who were clinically unlikely to have this syndrome also had negative laboratory tests. CONCLUSION: In a series of 51 unselected patients presenting with stroke and transient ischemic attacks, three had the antiphospholipid syndrome. The clinical features of this syndrome are helpful in identifying this group of patients. The role of the lupus anticoagulant in the pathogenesis of stroke remains to be defined., Antiphospholipid antibodies are abnormal immune, or natural defense, proteins that specifically bind to phosphate-containing lipids or fatty groups. These antibodies have been associated with recurrent blood clotting, repeated miscarriage, and an abnormal decrease in the number of platelets (which are cells involved in blood clotting). Lupus anticoagulant, a factor that prevents or delays blood clotting, has been detected in patients with lupus erythematosus, an inflammatory disorder of connective tissue. The combined presence of lupus anticoagulant, antiphospholipid antibodies, and related symptoms has been referred to as the antiphospholipid syndrome. Both antiphospholipid antibodies and lupus coagulant have been detected in patients with stroke, and may serve as markers for the clotting state of these patients. Stroke is the sudden loss of consciousness followed by paralysis, and results from the blockage of blood vessels supplying the brain or from bleeding within the brain due to rupture of a blood vessel. The prevalence of the antiphospholipid syndrome was assessed in 51 patients with stroke and transient ischemic attacks (brief episodes of cessation of blood supply to the brain). Among 51 patients, 3 had lupus anticoagulant and symptoms of the antiphospholipid syndrome; 7 patients had clinical symptoms, but no laboratory evidence of the syndrome. Patients without clinical symptoms of this syndrome did not have laboratory evidence of the disease. These findings indicate that clinical features are useful indicators of the antiphospholipid syndrome. The role of lupus anticoagulant in the disease process which leads to stroke requires further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cerebellar hemangioblastoma is a rare cause of secondary erythrocytosis. Although the erythrocytosis is a result of erythropoietin (Ep) stimulation, direct evidence of Ep synthesis by the tumor has been lacking. In an erythrocytotic patient with a cerebellar hemangioblastoma we found elevated levels of Ep in the tumor cyst fluid and for the first time demonstrated Ep mRNA in the tumor by Northern blotting. This finding confirms cerebellar hemangioblastoma as a site of ectopic Ep production.

A case of metastatic breast carcinoma presenting as fatal fulminant hepatic failure is presented. The patient did not have previously diagnosed breast cancer and presented with ascites, Jaundice, abdominal pain, nausea, vomiting and hepatic encephalopathy. She died within four weeks of the onset. Seven similar cases previously reported are reviewed. Metastatic carcinoma should he considered in the differential diagnosis of fulminant hepatic failure.