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Letter to the editor
Tip of the iceberg in idiopathic intracranial hypertension
  1. Susan P Mollan1,2,
  2. James L Mitchell2,
  3. Alexandra J Sinclair3
  1. 1 Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Trust, Birmingham, UK
  2. 2 Metabolic Neurology, University of Birmingham, Birmingham, UK
  3. 3 Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Dr Alexandra J Sinclair, Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B152TT, UK; a.b.sinclair{at}bham.ac.uk

https://doi.org/10.1136/practneurol-2019-002198

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    Lumbar puncture (LP) is a critical part of the diagnostic algorithm to measure opening pressure and contents in all those presenting with raised intracranial pressure (ICP).1–4 Idiopathic intracranial hypertension (IIH) is a diagnosis of exclusion, and at the point of initial presentation, there is no clinically recognised sign that can diagnose IIH above other causes of raised ICP.1–4 Gates et al 5 raise an interesting discussion regarding needle tip type for the LP procedure in those who are diagnosed subsequently with IIH.5 While the first guidelines in IIH1 and the European IIH guidelines2 have recommended that therapeutic serial LPs are not advocated as a long-term treatment strategy for IIH due to the lack of high-quality peer-reviewed evidence,1 2 to …

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    Footnotes

    • Contributors All authors have read and approved the final manuscript.

    • Funding AJS is funded by an NIHR Clinician Scientist Fellowship (NIHR-CS-011-028) and by the Medical Research Council, UK (MR/K015184/1).

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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