Kabanovski et al. [1] published a retrospective, single metropolitan centre study that concluded that cranial venography is unnecessary in the investigation of papilloedema. This differs from recommended clinical practice for papilloedema investigation and idiopathic intracranial hypertension diagnosis, both in the United Kingdom and abroad [2, 3]. Although cerebral venous sinus thrombosis (CVST) is rare, it has a notoriously high risk of mortality and morbidity if untreated. Once identified by neuroimaging and appropriately treated with anticoagulation, survival to full functional recovery is the norm [4].

To fully assess the conclusions of Kabanovski et al. [1] it is important to know how many patients they excluded due to CVST risk factors and the number with CVST in that group. They appear not to have excluded those on oral contraception and those using fertility drugs, both of which are common CVST risk factors in females [4].

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