In their article on the prevalence of anticardiolipin antibodies in patients with idiopathic intracranial hypertension, Leker and Steiner1 state that "the incidence of anticardiolipin antibodies in idiopathic intracranial hypertension has not been systematically studied... ." Obviously they were unaware of work carried out at this institution.2 Sussman and colleagues3 looked for abnormalities of coagulation in 38 patients with the syndrome of idiopathic intracranial hypertension and found evidence of antiphospholipid antibodies (anticardiolipin antibody and/or lupus anticoagulant) in 12 cases (32%), in 1 of 18 healthy obese controls, and 3 of 24 controls with other neurologic disease. The patients were similar, but not identical in the 2 studies. Only 18 of the patients studied by Sussman and colleagues had had imaging of the intracranial venous system (angiography) and 3 had evidence of dural sinus thrombosis and would have been excluded from the series reported by Leker and Steiner. Nevertheless, the results obtained by Leker and Steiner are remarkably similar to the earlier study, with 6 of their 14 patients having positive anticardiolipin antibody, and although the rates of positivity in suitable controls from the same population are not provided, this second study is further evidence that this is a real association and warrants further investigation. We need to determine how persistent antiphospholipid antibodies are in these patients, their relationship to prognosis, their relationship with other possible risk factors (the nonobese patients may be more likely to have antiphospholipid antibodies3) and whether they affect the response to treatments, both those conventionally used for idiopathic intrcranial hypertension and those used for other antiphospholipid antibody syndromes.
Howell SJL. Anticardiolipin Antibodies. Arch Neurol. 1999;56(6):760. doi:
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