Is Lumbar Puncture necessary for Diagnosis of Idiopathic Intracranial Hypertension?

Generally, patients displaying Typical Pseudotumor Cerebri syndrome (PTCS) symptoms must have a lumbar puncture (LP) to demonstrate elevated opening pressure and cerebrospinal fluid (CSF) analysis to rule out the various other diagnoses. As lumbar puncture may be associated with significant morbidity, the researchers conducted a study to determine its necessity in diagnosing typical pseudotumor cerebri syndrome (PTCS).

According to a new study, Lumbar Puncture may not be required in the initial evaluation of typical patients with pseudotumor cerebri syndrome (PTCS) with Idiopathic Intracranial Hypertension evaluated by experienced clinicians.

Although generally lumbar punctures (LPs) are used for diagnostic evaluation in idiopathic intracranial hypertension (IIH), they can also provide relief from Idiopathic Intracranial Hypertension associated headache. 

This study was conducted by Mathew S Margolis and team with the objective to ascertain usefulness of LP in diagnosing typical PTCS. The results of this study were published in the Journal of Neuro-Ophthalmology on 3rd December, 2021. This was a retrospective study that included women aged 18 to 45 years with body mass index of more than 25 m2, papilledema, negative neuroimaging, and who met criteria for PTCS or probable PTCS at three university-based neuro-ophthalmology practices.

A total of 156 patients were enrolled in this study. Clinically insignificant CSF abnormalities were found in seven people (4.5 percent). No diagnoses or management were altered as a result of the LP / CSF results. In conclusion, the Authors wanted to add caution that, even when there is no mandate of using LP, however, more prospective research is needed to determine the potential risks and benefits of LP as a tool in the diagnosis of Idiopathic Intracranial Hypertension (IIH) before recommending changes to general practice.

Reference:

Margolis MS, DeBusk AA, Moster ML, Falardeau JM, Eggenberger ER, Sergott RC, Van Stavern GP. Lumbar Puncture for Diagnosis of Idiopathic Intracranial Hypertension in Typical Patients. J Neuroophthalmol. 2021 Sep 1;41(3):375-378. doi: 10.1097/WNO.0000000000001319.