The symptoms typical of a stroke are not always associated with blockage of a major blood vessel in the brain; symptoms indistinguishable from stroke may affect patients labelled as having multiple sclerosis—only the age of the patient and a history of other symptoms allow it to be distinguished from a stroke. A condition that must be considered in patients with a stroke has already been referred to in relation to multiple sclerosis; it is the disease associated with thrombosis known as the anti-phospholipid syndrome, discovered by Dr. Graham Hughes in the 1980s, often referred to as the Hughes syndrome.18 When it affects the nervous system it mimics multiple sclerosis and so provides yet more confirmation that the disease underlying the formation of the areas of sclerosis starts in the blood vessels. A hundred years before the anti-phospholipid syndrome was discovered, Harald Ribbert, a German pathologist, had suggested that multiple sclerosis was associated with thrombosis, after he had seen that the earliest damage surrounded veins. Hughes syndrome is one cause of venous thrombosis, although it may also cause arterial thrombosis and embolism. Optic neuritis and paraplegia from damage to the spinal cord may also occur in Hughes syndrome, just as they do in multiple sclerosis, almost certainly from tiny emboli breaking off from an area of thrombosis. It is most important for the diagnosis of Hughes syndrome to be made, because the condition can be treated with aspirin and other drugs to prevent further attacks. However, it is also clear from the localised brain swelling seen on MRI in patients with the anti-phospholipid syndrome, that the attacks are likely to respond to hyperbaric oxygen treatment.
References: 18. Hughes GRV. The anticardiolipin syndrome. Clin Exp Rheumatol 1985;3:285
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