The authors report the findings from 14 patients following treatment for idiopathic intracranial hypertension (IIH). All 14 patients experienced an immediate and sustained resolution of the IIH in the setting of prolonged cerebrospinal fluid (CSF) drainage at a rate greater than CSF production: 13 in the setting of a low pressure headache (11 after a lumbar puncture, one with a lumbar drain and one with a shunt) and one patient who was intentionally treated for four days with a lumbar drain. The authors suggest that an immediate and sustained resolution of IIH does not reflect the ‘natural history’ of patients treated with drugs such as acetazolamide, optic nerve fenestration, lumboperitoneal shunt or transverse sinus stenting. They acknowledge that they are not the first to report resolution of symptoms in the setting of low pressure headaches. The authors suggest the possible mechanisms responsible for the resolution of symptoms with prolonged CSF drainage as well as the possible implications of this finding. They suggest further investigation of their case report findings using a multi-centre study with a centralised database. 

A possible role for temporary lumbar drainage in the management of idiopathic intracranial hypertension.
Gates P, McNeill P.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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