Antiphospholipid antibody syndrome (APS) is a multisystem autoimmune disease characterized by venous or arterial thrombosis and/or pregnancy morbidity in the presence of persistent antiphosholipid antibodies (aPLs). Central nervous system is often affected and thrombotic or embolic ischaemic stroke (IS) is the most frequent complication. Intracranial stenosis or occlusion accounts for about 50% of APS patients, especially in the Middle cerebral artery territory (MCA). We report a case of a young woman with recurrent cerebral ischemic lesions and history of miscarriages. In 2015 a 43 years old woman was admitted to Emergency Department (ED) due to a left brachial weakness at wake-up from an ischemic fronto-parietal lesions and steno-occlusion of the proximal M1 segment of the right Middle Cerebral Artery (MCA). She had a history of arterial hypertension, migraine, previous transient ischemic attack (TIA) and was a tobacco smoker. Diagnostic workup showed high levels of aPLs. She was discharged with improved clinical conditions on antiplatelet and steroid therapy, but she had recurrent IS a month later and three years later. In the same period, she reported two miscarriages. Follow up lab tests confirmed high-titre of aPLs. Therefore, diagnosis of APS was validated. A direct oral anticoagulant was started. No recurrent events occurred over the next 2-year follow-up. Stroke is a common manifestation in APS. Diagnosis of APS is not easy. Prospective data on the therapeutic approach to APS patients with IS are scarce and recurrence rate of thrombotic events among APS patients are high, despite anticoagulation

Cerebral venous sinus thrombosis (CVST) is the thrombosis of dural sinuses and deep and/or superficial cerebral venous system. Sex specific risk factors in women such as oral contraceptive use, pregnancy and hormone therapy seem to be associated with increased risk of CVST. We present a 24 year-old female, primigravida, that was admitted to the emergency department with a generalized tonic clonic seizure two weeks after normal vaginal delivery and left sided weakness. She reported a severe headache in the previous three days, nausea and vomitting. Cortico-subcortical areas of higher signal intensity in bilateral parietal and left frontal regions with no arterial distribution were observed in the brain magnetic resonance imaging (MRI). Cranial MR venography revealed venous thrombosis in the anterior two thirds of the superior sagittal sinus. The patient was diagnosed as cerebral venous sinus thrombosis due to puerperium and treated with heparin transitioned to therapeutic oral warfarin. During her hospital stay in the fourth day she had another generalized tonic clonic seizure. Levetiracetam was initiated with an optimal dose of 1000 mg/daily. She was discharged with full recovery