Assessing possibility of deferring lumbar puncture in mild idiopathic intracranial hypertension
Reviewed by Lauren Hepworth

This was a retrospective review of patients consecutively presenting with idiopathic intracranial hypertension (IIH) to a tertiary neuro-ophthalmology clinic without a lumbar puncture (LP) over an eight-year period. Inclusion criteria included true optic disc oedema, retinal nerve layer thickness ≤300µm, preserved visual function, absence of secondary raised intracranial pressure (ICP) and absence of neoplasm / infective process on MRI. A total of 132 eyes from 68 patients were included in the analysis. LPs were deferred in 68 cases due to either patient refusal, clinical judgement or failed attempts. Neuroimaging found no secondary cause and an empty or partially empty sella was identified in 91% of cases. All patients received weight loss counselling. Two patients started medical treatment of acetazolamide. No significant loss of vision was reported, and resolution of papilloedema was noted for 76 eyes. The authors suggest that LP can be deferred if the patient is systemically well, fits the typical IIH demographic, mild optic disc oedema, no secondary cause and regular neuro-ophthalmology follow-up. The risks and benefits should always be discussed with the patient. These findings could potentially prevent unnecessary procedures which cause psychological distress to the patient and use healthcare resources.

Can lumbar puncture be safely deferred in patients with mild presumed idiopathic intracranial hypertension?
Vosoughi AR, Margolin EA, Micieli JA.
JOURNAL OF NEURO-OPHTHALMOLOGY
2022;42:505-8.