Lumbar Puncture for Diagnosis of Idiopathic Intracranial Hypertension in Typical Patients.
Journal
Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
ISSN: 1536-5166
Titre abrégé: J Neuroophthalmol
Pays: United States
ID NLM: 9431308
Informations de publication
Date de publication:
01 Sep 2021
01 Sep 2021
Historique:
pubmed:
10
8
2021
medline:
8
1
2022
entrez:
9
8
2021
Statut:
ppublish
Résumé
Patients with typical features of pseudotumor cerebri syndrome (PTCS) must undergo lumbar puncture (LP) to demonstrate elevated opening pressure and cerebrospinal fluid (CSF) analysis to rule out alternative diagnoses. As LP may be associated with significant morbidity, this study aims to determine its necessity in diagnosing typical PTCS. Retrospective chart review at 3 university-based neuro-ophthalmology practices included women aged 18-45 years with body mass index >25, papilledema, negative neuroimaging, and who met criteria for PTCS or probable PTCS. One hundred fifty-six patients were enrolled. Seven (4.5%) had clinically insignificant CSF abnormalities. No diagnoses or management changed based on LP/CSF results. LP may not be routinely required in the initial evaluation of typical patients with PTCS evaluated by experienced clinicians We caution, however, that further prospective study is required to determine potential risks and benefits of LP as a tool in the diagnosis of IIH before recommending general practice changes.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with typical features of pseudotumor cerebri syndrome (PTCS) must undergo lumbar puncture (LP) to demonstrate elevated opening pressure and cerebrospinal fluid (CSF) analysis to rule out alternative diagnoses. As LP may be associated with significant morbidity, this study aims to determine its necessity in diagnosing typical PTCS.
METHODS
METHODS
Retrospective chart review at 3 university-based neuro-ophthalmology practices included women aged 18-45 years with body mass index >25, papilledema, negative neuroimaging, and who met criteria for PTCS or probable PTCS.
RESULTS
RESULTS
One hundred fifty-six patients were enrolled. Seven (4.5%) had clinically insignificant CSF abnormalities. No diagnoses or management changed based on LP/CSF results.
CONCLUSION
CONCLUSIONS
LP may not be routinely required in the initial evaluation of typical patients with PTCS evaluated by experienced clinicians We caution, however, that further prospective study is required to determine potential risks and benefits of LP as a tool in the diagnosis of IIH before recommending general practice changes.
Identifiants
pubmed: 34369470
doi: 10.1097/WNO.0000000000001319
pii: 00041327-202109000-00015
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
375-378Informations de copyright
Copyright © 2021 by North American Neuro-Ophthalmology Society.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Smith SV, Friedman DI. The idiopathic intracranial hypertension treatment trial: a review of the outcomes. Headache. 2017;57:1303–1310.
Mollan SP, Ali F, Hassan-Smith G, Botfield H, Friedman DI, Sinclair AJ. Evolving evidence in adult idiopathic intracranial hypertension: pathophysiology and management. J Neurol Neurosurg Psychiatry. 2016;87:982–992.
Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2013;81:1159–1165.
Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol. 1982;39:461–474.
Bidot S, Bruce BB. Update on the diagnosis and treatment of idiopathic intracranial hypertension. Semin Neurol. 2015;35:527–538.
Schwartz KM, Luetmer PH, Hunt CH, Kotsenas AL, Diehn FE, Eckel LJ, Black DF, Lehman VT, Lindell EP. Position-related variability of CSF opening pressure measurements. AJNR Am J Neuroradiol. 2013;34:904–907.
DeBusk A, Moster ML, Sergott RC, Bryan MS. Lumbar puncture for diagnosis of idiopathic intracranial hypertension. Poster Presentation—North American Neuro-Ophthalmology Society (NANOS) 43rd annual meeting; Washington DC. 2017, April 1–6.
Basurto Ona X, Solà I, Bonfill Cosp X. Drug therapy for treating post‐dural puncture headache. Cochrane Database Syst Rev. 2009:CD007887.
Williams J, Lye DC, Umapathi T. Diagnostic lumbar puncture: minimizing complications. Intern Med J. 2008;38:587–591.
Monserrate AE, Ryman DC, Ma S, Xiong C, Noble JM, Ringman JM, Morris JC, Danek A, Müller-Sarnowski F, Clifford DB, McDade EM, Brooks WS, Darby DG, Masters CL, Weston PS, Farlow MR, Graff-Radford NR, Salloway SP, Fagan AM, Oliver A, Bateman RJ; Dominantly Inherited Alzheimer Network. Factors associated with the onset and persistence of post-lumbar puncture headache. JAMA Neurol. 2015;72:325–332.
Wang YF, Fuh JL, Lirng JF, Chen SP, Hseu SS, Wu JC, Wang SJ. Cerebrospinal fluid leakage and headache after lumbar puncture: a prospective non-invasive imaging study. Brain. 2015;138:1492–1498.
van Oosterhout WP, van der Plas AA, van Zwet EW, Zielman R, Ferrari MD, Terwindt GM. Postdural puncture headache in migraineurs and nonheadache subjects: a prospective study. Neurology. 2013;80:941–948.
Lu P, Goyal M, Huecker JB, Gordon MO, Van Stavern GP. Identifying incidence of and risk factors for fluoroscopy-guided lumbar puncture and subsequent persistent low-pressure syndrome in patients with idiopathic intracranial hypertension. J Neuroophthalmol. 2019;39:161–164.
Beechar VB, Zinn PO, Heck KA, Fuller GN, Han I, Patel AJ, Ropper AE. Spinal epidermoid tumors: case report and review of the literature. Neurospine. 2018;15:117–122.
Joffe AR. Lumbar puncture and brain herniation in acute bacterial meningitis: a review. J Intensive Care Med. 2007;22:194–207.
Kroll H, Duszak R, Nsiah E, Hughes DR, Sumer S, Wintermark M. Trends in lumbar puncture over 2 decades: a dramatic shift to radiology. Am J Roentgenol. 2014;204:15–19.
Dakka NW Y, Albadareen RJ, Jankowski M, Silver B. Headache rate and cost of care following lumbar puncture at a single tertiary care hospital. Neurology. 2011;77:71–74.
Cauley KA. Fluoroscopically guided lumbar puncture. Am J Roentgenol. 2015;205:W442–W450.
Menger R, Wa P, Hefner M, Nanda A, Cuellar H. Economic outcomes of the addition of fluoroscopic guidance to the lumbar puncture procedure: a call for standardized training. J Spine. 2017;6:1.