Insights into the treatment of Idiopathic Intracranial Hypertension with an LP or temporary lumbar drain

Six cases that provide insights into the pathophysiology of IIH and a new approach to management will be discussed. Four developed a low-pressure headache, 2 after an LP, 1 with a malfunctioning lumbo-peritoneal(L-P) shunt, 1 with a malfunctioning ventriculo-peritoneal (V-P) shunt. All 4 went into remission. One case describes the influence of LP-induced progressive lowering of CSF pressure on transverse sinus narrowing and 1 illustrates that an epidural blood patch did not prevent the resolution of IIH in the setting of a low-pressure headache. These cases provide a potential explanation for why IIH sometimes resolves following a lumbar puncture and why it recurs when ventriculo-peritoneal and LP shunts occlude. In our case series of 90 patients, 27 had an LP-induced remission, 14 in the setting of low-pressure headache. Four patients had a temporary lumbar drain-induced remission

The concept of using a “therapeutic LP” or a temporary lumbar drain represents a potential paradigm shift in the management of IIH.