Antiphospholipid antibody syndrome (APS) is a rare but known cause of stroke, especially in the young. Ischemic stroke is the most common neurological manifestation of APS, however it is not known if APS causes a specific pattern of infarction on imaging. Cortical large vessel and lacunar infarcts have both been noted in patients with APS.

We performed a literature search using PubMed with keywords antiphospholipid antibody syndrome, stroke, brain imaging, MRI, and MRI imaging. We identified case reports, prospective studies, retrospective chart reviews and systematic reviews that discussed patients with APS, their imaging and management.

Of the studies that were reviewed, multiple findings were seen on imaging. These included cortical and subcortical infarcts, borderzone infarcts, white matter hyperintensities, and cortical atrophy. Vascular imaging demonstrated stenoses and occlusions in anterior and posterior arterial circulation, and cerebral venous thrombosis.

Although some studies had their limitations, they did not support the hypothesis that brain imaging helps in the diagnosis and management of APS. Various patterns of infarction, including large territorial infarcts, lacunar infarcts in deep white matter, borderzone infarcts, were seen. Imaging should be only used as an inferential tool to determine stroke etiology and make treatment decisions.