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The study by Kesler et al 1 concludes with the assumption that the presence of anticardiolipin antibodies (aCL-Abs) indicates a unique subgroup of patients with idiopathic intracranial hypertension. Their study does not support this view. They regard as important in this respect the fact that the three patients with aCL-Abs (p<0.035) were significantly older than those without. This is hardly surprising when it is known that the incidence of these antibodies increases with age and may be identifiable in up to 12% of healthy people.2 3 Their control group therefore needs to be age matched. Further speculation for this conclusion is in their statement that there may have been an occult thrombosis of the cerebral venous sinuses, a fact that I agree with as CT and MRI cannot exclude a thrombosis for certain–hence intracranial hypertension would not be the diagnosis. It is not stated how soon cerebral sinus imaging was performed after the onset of symptoms. Thirdly, the concentration of raised aCL-Ab in these patients is not very high apart from the initial measurement in patient 1. Titres less than 40 units are generally not thought to be pathological but this is quite an arbitrary figure as test systems are variable and not standardised.4 Fourthly, with a prevalence of aCL-Ab at 5% in Israel, the presence of these antibodies in three of 37 patients is not a significant finding (χ2; p>0.45). Finally, it is an accepted view that the presence of aCL-Ab may represent an epiphenomenon due to a non-specified injury. This is supported by the incidental findings of aCL-Ab in symptom-free patients.5 Hence the findings cannot support the authors' proposal that the patients with aCL-Ab form a subgroup of patients with intracranial hypertension.
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