In this study, the spectrum of acute cerebrovascular disease in patients with antiphospholipid syndrome (APS), their differences between stroke subtypes, as well as long-term functional results were examined; findings demonstrated no differences between stroke subtypes and APS types. There was no association of aPL (antiphospholipid antibodies) profiles with any of the acute cerebrovascular diseases described in this cohort. Cerebral venous thromboses (CVT) could represent an initial thrombotic presentation of APS with low mortality and good long-term functional results.

• This retrospective cohort study comprised adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019.

• Analyses included 120 cases; 99 (82.5%) women; median age 43 years; 63.3% had secondary APS; there were similar demographics, comorbidities, and aPL positivity between APS type and stroke subtypes.

• Of index events, 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) CVT, 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH) were observed.

• Known APS cases were 55.8%; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12–96).

• At ≥4 years after APS diagnosis, 64.7% of intracranial hemorrhages (ICH or SAH) developed (23.5% anticoagulation-related); 63.2% of CVT occurred before APS was diagnosed or simultaneously.

• Overall 22.8% cases had recurrences, AIS, in 69.2%; intracranial hemorrhage, in 30.8%.

• Good long-term functional outcomes were achieved (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause death rate was 19.2%.