Sneddon's syndrome

Medical condition

Sneddon syndrome
Other names	Ehrmann-Sneddon syndrome, Livedo racemosa-cerebrovascular accident syndrome, Livedo reticularis-cerebrovascular accident syndrome, Sneddon-Champion syndrome, Livedo reticularis racemosa

This condition may be inherited in an autosomal dominant manner, but is more often sporadic
Specialty	Rheumatology

Sneddon's syndrome is a form of arteriopathy characterized by several symptoms, including:

Severe, transient neurological symptoms or stroke
Livedo reticularis, or livedo racemosa

Signs and symptoms

Sneddon's syndrome generally manifests with stroke or severe, transient neurological symptoms, and a skin rash (livedo reticularis). Livedo reticularis appears as a bluish-purple, netlike mottling of the skin. Sneddon's syndrome may instead present with livedo racemosa, which involves larger, less organized patches of bluish-purple mottling of the skin. Both are generally found first in the extremities, both worsen in cold and either may occur without Sneddon's syndrome or any other systemic disease.

Sneddon's syndrome can be characterized by: transient amnesia, transient aphasia, palsy, headaches, hypertension, transient ischemic attacks (TIA), stroke, coronary disease and dementia. The skin manifestations may precede the neurologic symptoms by years.

Pathogenesis

Sneddon's syndrome is a progressive, noninflammatory arteriopathy leading to the characteristic skin condition and to cerebrovascular problems, including stroke, transient ischemic attack (TIA), severe but transient neurological symptoms thought to be caused by cerebral vasospasm, coronary disease and early-onset dementia. Progressive compromise of arterial linings in Sneddon's produces clotting, for which high-dose warfarin is most commonly prescribed, and can also cause the development of systemic arterial plaque when cholesterol levels are normal.

Diagnosis

There are no diagnostic tests on which all Sneddon's patients will have abnormal results, although brain MRI and skin biopsy are often abnormal. The diagnosis is based on a detailed history and physical examination. About 40-60% of patients with the syndrome test positive for antiphospholipid antibodies.

Treatment

Sneddon's patients are generally treated with warfarin, maintaining a high INR of 3–4. Because most will experience significant relief of symptoms after several months of consistent INR in this range, treatment with warfarin is often used as a diagnostic tool.

Epidemiology

Sneddon's syndrome is a rare condition that is usually misdiagnosed. It occurs in families and may be inherited in an autosomal dominant fashion. Sneddon's syndrome most often becomes apparent in women in their thirties, though cases do occur in men and in children. Generally, Livedo precedes cerebrovascular involvement by roughly ten years, and many years of cerebrovascular involvement precede the development of dementia, when it occurs.

History

It is named for Ian Bruce Sneddon. In 1965, Dr. Sneddon first reported 6 patients with a distinct skin rash and cerebrovascular accidents (strokes).Sneddon's Syndrome was formerly understood to be a type of autoimmune disease called antiphospholipid syndrome, although it has been reclassified as a noninflammatory cerebrovascular disease. It should be considered in patients diagnosed with vasculitis when standard treatments fail.

References

^ Berlit, Peter (March 2015). "Sneddon's Syndrome". Orphanet. Retrieved 12 June 2023.
"Sneddon Syndrome". Cleveland Clinic. 5 May 2022. Retrieved 12 June 2023.
^ Johnson, Klaus Wolff, Richard Allen (2009). Fitzpatrick's color atlas and synopsis of clinical dermatology (6th ed.). New York: McGraw-Hill Medical. p. Section 14. ISBN 978-0071599757.{{cite book}}: CS1 maint: multiple names: authors list (link)
Adams; et al. Principles of Neurology, 6th Edition. p. 861.
synd/1732 at Who Named It?
Sneddon IB (April 1965). "Cerebrovascular lesions and livedo reticularis". British Journal of Dermatology. 77 (4): 180–185. doi:10.1111/j.1365-2133.1965.tb14628.x. PMID 14278790. S2CID 43219068.

External links

Classification	D ICD-10: M30.8 (ILDS M30.820) OMIM: 182410 MeSH: D018860 DiseasesDB: 12257

Cerebrovascular diseases including stroke

Ischaemic stroke

Brain	Anterior cerebral artery syndrome Middle cerebral artery syndrome Posterior cerebral artery syndrome Amaurosis fugax Moyamoya disease Dejerine–Roussy syndrome Watershed stroke Lacunar stroke
Brain stem	Brainstem stroke syndrome Medulla Medial medullary syndrome Lateral medullary syndrome Pons Medial pontine syndrome / Foville's Lateral pontine syndrome / Millard-Gubler Midbrain Weber's syndrome Benedikt syndrome Claude's syndrome
Cerebellum	Cerebellar stroke syndrome
Extracranial arteries	Carotid artery stenosis precerebral Anterior spinal artery syndrome Vertebrobasilar insufficiency Subclavian steal syndrome
Classification	Brain ischemia Cerebral infarction Classification Transient ischemic attack Total anterior circulation infarct Partial anterior circulation infarct
Other	CADASIL Binswanger's disease Transient global amnesia

Haemorrhagic stroke

Extra-axial	Epidural Subdural Subarachnoid
Cerebral/Intra-axial	Intraventricular
Brainstem	Duret haemorrhages
General	Intracranial hemorrhage

Aneurysm

Intracranial aneurysm
- Charcot–Bouchard aneurysm

Other

Pauci-immune	c-ANCA Granulomatosis with polyangiitis p-ANCA Eosinophilic granulomatosis with polyangiitis Microscopic polyangiitis
Type III hypersensitivity	Cutaneous small-vessel vasculitis IgA vasculitis
Ungrouped	Acute hemorrhagic edema of infancy Cryoglobulinemic vasculitis Bullous small vessel vasculitis Cutaneous small-vessel vasculitis

Other

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