Prevalence of antinuclear antibody in patients with multiple sclerosis: a case-control study

Background Antinuclear antibody (ANA) is a common test for excluding alternative diagnoses. However, the significance of ANA testing in patients with multiple sclerosis (MS) remains unclear. Objectives To compare the prevalence of positive ANA antibody and its titer between patients with MS (cases) and non-MS patients who attended neurology clinics (control) in Saudi Arabia. Methods A case-control review of ANA results for all patients who attended a neurology MS clinic. We compared a convenience sample of patients with MS with individuals with general neurology problems and no known autoimmune diseases. Results There were 115 and 103 participants in the MS and control group, respectively. The mean age in the MS and control group was 33.76 ± 8.96 years and 34.95 ± 8.56 years, respectively. In the MS group, 25.22%, 60%, 11.30%, and 3.48% were negative, mildly positive, moderately positive, and strongly positive for ANA, respectively. In the control group, there were 34.95%, 54.37%, and 10.68% were negative, mild positive, and moderate positive, respectively. There were numerically, but not significantly, more positive cases in the MS group (74.78%) than in the control group (65.05%) (p = .117). Conclusion ANA testing in routine MS screening for excluding alternative diagnoses should be discouraged unless there is a remarkable history or clinical examination finding. Mild positive ANA is common among patients with MS and does not significantly differ from the general population.

Key Diagnostic Finding in a Condition with Variable Clinical Presentations

This is an interesting case series on a very common genetic condition which are often diagnosed late as clinical signs are inconspicuous. We would like to highlight the principal clinical examination finding which led to diagnosis.

Popliteal Traumatic Arteriovenous Fistula

Popliteal trauma requires particular attention because blood vessel injuries in that zone might cause serious complications. Popliteal traumatic arteriovenous fistula (AVF) should be considered for serious leg amputation, and long-standing fistulae produce cardiac overload. The diagnosis is usually made after clinical examination, finding palpable thrill and audible bruit over the injury site, and is confirmed after duplex ultrasonography and/or angiography. We present a case of popliteal traumatic arteriovenous fistula with false aneurysm (pseudoaneurysm) (PSA), in which duplex ultrasonography and angiography findings proved inconsistent with the findings at surgery, thus resulting in an unnecessary extensive dissection of a major artery and vein, whereas the fistula and the PSA were found in minor vessels (genicular artery and vein).