Identifying Incidence of and Risk Factors for Fluoroscopy-Guided Lumbar Puncture and Subsequent Persistent Low-Pressure Syndrome in Patients With Idiopathic Intracranial Hypertension

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Title Identifying Incidence of and Risk Factors for Fluoroscopy-Guided Lumbar Puncture and Subsequent Persistent Low-Pressure Syndrome in Patients With Idiopathic Intracranial Hypertension
Creator Patricia Lu; Manu Goyal; Julia B. Huecker; Mae O. Gordon; Gregory P. Van Stavern
Affiliation Department of Ophthalmology and Visual Sciences (PL, JBH, MOG, GPVS), Washington University School of Medicine, St. Louis, Missouri; Mallinckrodt Institute of Radiology (MG), Washington University School of Medicine, St. Louis, Missouri; and Department of Neurology (MG, GPVS), Washington University School of Medicine, St. Louis, Missouri
Abstract Background: To explore the incidence of and potential risk factors for developing persistent low-pressure syndrome after lumbar puncture (LP) in patients with idiopathic intracranial hypertension (IIH), as measured by use of blood patches. Methods: A retrospective chart review was conducted of patients with definitively diagnosed IIH by clinical examination and LP, comparing them to patients with multiple sclerosis (MS) as controls who also received diagnostic LPs. Demographic, clinical, and radiological data were collected for each patient. The main outcome measure was the rate of post-LP blood patches in IIH patients compared with MS patients. Secondary outcome measures were the likelihood of undergoing an epidural blood patch related to age, body mass index, volume removed, opening pressure, the difference between opening and closing pressure, and the level of puncture within the IIH cohort. Results: One hundred four IIH patients and 149 MS patients were included in the study. Among IIH patients, 12/104 (11.5%) underwent an epidural blood patch after LP as compared to 8/149 (5.4%) of the MS control patients (P = 0.086). Within the IIH population, none of the clinical or LP parameters were significantly correlated with increased risk of needing a blood patch. Conclusions: The incidence of low-pressure syndrome, as measured by blood patches, is similar in IIH patients and MS controls. This suggests that having elevated intracranial pressure before an LP is not protective against developing postpuncture low-pressure syndrome, contrary to common assumptions.
Subject Adult; Blood Patch, Epidural; Cerebrospinal Fluid Leak / diagnosis; Cerebrospinal Fluid Leak / epidemiology; Cerebrospinal Fluid Leak / therapy; Female; Fluoroscopy; Humans; Incidence; Intracranial Hypotension / diagnosis; Intracranial Hypotension / epidemiology; Intracranial Hypotension / therapy; Intracranial Pressure; Male; Middle Aged; Multiple Sclerosis / complications; Pseudotumor Cerebri / complications; Retrospective Studies; Risk Factors; Spinal Puncture / adverse effects; Syndrome; Young Adult
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Date 2019-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2019, Volume 39, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6xt1jx8
Setname ehsl_novel_jno
ID 1595797
Reference URL https://collections.lib.utah.edu/ark:/87278/s6xt1jx8
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