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.

Prof. Peter Colin Gates is working at  Deakin University Waurn Ponds Vic Australia. His research interests are Cerebral Vascular Disease, Hypertension, Obesity, Idiopathic Intracranial Hypertension.