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Images in Neurology |

The Sneddon Syndrome

Yasser Aladdin, MD; Mohamad Hamadeh, MD, FRCP(C); Ken Butcher, MD, PhD, FRCP(C)
Arch Neurol. 2008;65(6):834-835. doi:10.1001/archneur.65.6.834.
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A 47-year-old woman with hypertension presented with ataxia and nystagmus. She had been having recurrent ischemic strokes since 25 years of age. Cranial magnetic resonance imaging revealed a right cerebellar infarct and multiple old cortical and subcortical infarcts within various vascular territories (Figure 1). Lacy purplish cutaneous mottling consistent with livedo reticularis had been present in the legs since adolescence (Figure 2). Stigmata of connective tissue disorders were absent. Laboratory values for inflammatory indexes, syphilis serology, and autoimmune antibody panels, including lupus anticoagulants and anticardiolipin antibodies, were all normal. Echocardiographic evaluation displayed normal cardiac parameters. Finally, the diagnosis of Sneddon syndrome was entertained and the patient underwent anticoagulation.

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Figure 1.

A, Axial fluid-attenuated inversion recovery magnetic resonance image shows multiple bihemispheric old infarcts. B, T2-weighted sequence shows an acute right cerebellar infarction. Note the cerebral atrophy reflecting an advanced stage of Sneddon syndrome (arrow).

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Figure 2.

Coarse livedo reticularis appears in the lower extremities with characteristic lacy (fishnet pattern) purple cutaneous discolorations surrounding pale central areas.

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