Developing a comprehensive idiopathic intracranial hypertension pathway in a neurology same day emergency care service

<h3></h3> With rising levels of obesity, the incidence of idiopathic intracranial hypertension (IIH) is increasing. The disease is generally of insidious onset but can represent an emergency when vision is threatened. Patients often present acutely to the A+E department as concerns are raised elsewhere, either by an ophthalmologist or an optician, of papilloedema. These patients present a particular logistical challenge to our novel neuro-SDEC service at UCLH which receives a high number of referrals of patients presenting acutely with suspected IIH. Prompt diagnosis of IIH requires a) history and examination, including fundoscopy; b) neuroimaging; c) slit-lamp examination and optical coherence tomography, at an ophthalmology service in a separate hospital; and d) lumbar puncture, often on ambulatory care or neurology daycare, with some patients requiring X-ray guided procedures. Presently, a variety of practices in diagnosis and then subsequent management are followed, with no clear pathway in place for efficient diagnosis and treatment. We will present the findings of an ongoing audit of patients presenting to our neuro-SDEC service with suspected IIH from August-December 2023, highlighting times from presentation to OCT, LP and final diagnosis. We will describe progress in developing a comprehensive pathway designed to circumnavigate these logistical delays.