Antiphospholipid antibody, head-shaking and ataxia: An evidence of non-vascular neurotoxicity and successful treatment by plasmapheresis

Although antiphospholipid antibodies (APAbs) are considered to possess neurotoxic property, their relation with non-vascular neurological disorder is still disputed. This dilemma is mainly due to only a cross-sectional analysis or sporadic pictorial description in previous reports. In addition, treatment strategy is unknown in this situation. We encountered a patient who exhibited head-shaking and cerebellar ataxia had an increase of blood anti-beta2- glycoprotein I antibody and anticardiolipin antibody. Her neurological deficits did not respond to corticosteroid pulse therapy but rapidly subsided after plasmapheresis associated with a normalization of APAbs. Accordingly, a causal relation between APAbs and non-vascular neurological disorder is favored. The pathogenesis of APAb-related non-vascular neurotoxicity is warranted for further study to avoid premature conclusion. Plasmapheresis is recommended when movement disorder responds poorly to conventional treatment, especially when APAb is found.