Can Lumbar Puncture Be Safely Deferred in Patients With Mild Presumed Idiopathic Intracranial Hypertension?

We examined the clinical course of a subset of presumed patients with IIH with mild vision loss and papilledema to determine whether LP can be safely deferred in this group. Methods: This was a retrospective study looking at the clinical characteristics, final visual outcome, and diagnosis of patients with presumed IIH and papilledema determined by clinical examination who did not undergo LP. The inclusion criteria included i) no symptoms suspicious for systemic infectious/neoplastic/inflammatory processes, ii) no secondary causes of raised intracranial pressure seen on magnetic resonance imaging/magnetic resonance venography, iii) optical coherence tomography (OCT)-RNFL thickness ≤300 µm, and iv) automated mean deviation (MD) ≤ −5.00 dB v) at least one follow-up visit. Results: A total of 132 eyes of 68 patients (66 female and 2 male) were included in the study. The mean ± SD age was 31.4 ± 10.2 years, and body mass index was 35.1 ± 6.8 kg/m2. Systemic symptoms included headache (n = 47), pulsatile tinnitus (n = 28), transient visual obscurations (n = 10), and diplopia (n = 2). Presenting logarithm of the minimum angle of resolution visual acuity was 0.020 ± 0.090, automated MD was −2.23 ± 1.38 dB, and OCT RNFL thickness was 150.8 ± 48.4 µm. Patients were followed for a mean number of 63.3 ± 78.3 weeks. No additional cause of intracranial hypertension was discovered, and all patients remained systemically well. Two patients were started on acet...
Source: Journal of Neuro-Ophthalmology - Category: Opthalmology Tags: Original Contribution Source Type: research