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Published on: April 14, 2014
Rethinking routine lumbar puncture in isolated optic neuritis: results from a large cohort study
Romain Deschamps1, Marine Boudot de la Motte2, Emeline Chaugne2
1Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Service de Neurologie, Fondation Ophtalmologique Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France. rdeschamps@for.paris.
Background:
Lumbar puncture (LP) remains widely recommended in the diagnostic evaluation of isolated optic neuritis (ON), when brain MRI does not reveal lesions suggestive of multiple sclerosis (MS). However, the true clinical utility is unclear in the era of advanced serological and imaging diagnostics.
Methods:
In this monocentric retrospective study of all consecutive adult patients with acute or subacute ON and no MS-like lesions on initial brain MRI, we analyzed the final etiological diagnoses, the specific contribution of LP, and treatment timing.
Results:
Among 184 patients, diagnoses at the end of the follow-up (median 15.3 months) included idiopathic ON (48.4%), myelin oligodendrocyte glycoprotein-IgG associated disease (MOGAD; 22.3%), MS (19.6%), neuromyelitis optica spectrum disorders (4.3%), sarcoidosis (4.3%), and chronic lymphocytic leukemia-related ON (CLL; 1.1%). LP contributed to the final diagnosis in only 4 cases (2,2%), including 2 MOGAD (MOG-IgG only in cerebrospinal fluid) and 2 chronic lymphocytic leukemia-related ON, always in conjunction with other tests and clinical context. Conversely, spinal or orbital MRI and antibody testing were key diagnostic tools. Median delay between MRI and LP was 3 days, contributing to a median 11-day interval from symptom onset to corticosteroid treatment initiation.
Conclusions:
Routine LP has minimal diagnostic yield in isolated ON without MS-typical MRI findings and may delay treatment. Our results support a more selective, context-driven diagnostic strategy prioritizing MRI and antibody testing over systematic LP.
