It is also called as pseudotumor cerebri (PTC) as it presents with severe headaches and other symptoms of raised intracranial tension in absence of organic mass lesion. We describe the two most common causes of papilledema during pregnancy, idiopathic intracranial hypertension and cerebral venous thrombosis. As IIH is common in women of childbearing age, there will inevitably be patients diagnosed with IIH who become pregnant. Friedman recommended controlling weight gain during pregnancy to no more than 20lbs. IIH can occur at any trimester during pregnancy. The FDA describes a class B as: “Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.”[10] Because of the adverse effects of corticosteroids, they are generally reserved for acute settings of IIH in pregnancy. doi:10.1177/1591019916680110. report. Medications often can reduce this pressure and the headache, but in some cases, surgery is necessary.Pseudotumor cerebri can occur in children and adult… What is the preferred mode of delivery in idiopathic intracranial hypertension – do they all need a caesarean section. In 11, PTC started during pregnancy. A diagnostic lumbar puncture measuring the opening CSF pressures has no contraindications in pregnancy and may be done safely to aid in the diagnosis of IIH. Idiopathic intracranial hypertension (IIH) happens when high pressure around the brain causes symptoms like vision changes and headaches. Questions concerning past history of headache, associated symptoms, history of drug use during or before pregnancy, past psychiatric history, and a thorough review of symptoms are necessary. IIH in pregnancy is not a specific indication for a cesarean delivery and active labor is not contraindicated. View the article PDF and any associated supplements and figures for a period of 48 hours. Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that predominantly affects obese women of childbearing age. What is the extent of investigation before reaching the diagnosis of idiopathic intracranial hypertension? Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure without an identifiable underlying cause. pregnancy. There is no greater risk of recurrence of IIH for subsequent pregnancies when compared to the general population. Pregnancy can also be a time when the symptoms of intracranial hypertension first appear. Diet and Weight control: [] The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papilledema (see the image below), which may lead to secondary progressive optic atrophy, visual loss, and possible … There has been a single report by Worsham and colleagues in 1978, of sacrococcygeal teratoma, in an infant born to a mother treated with acetazolamide throughout her pregnancy. Some theories include increased CSF production, decreased CSF drainage, and increased cerebral venous sinus pressure as the leading cause. : Maternal neurosurgical shunts and pregnancy outcome. 2013;56(2):389–96. Idiopathic intracranial hypertension (IIH) is a disease particularly affecting young obese women of child-bearing age. If you have previously obtained access with your personal account, please log in. and you may need to create a new Wiley Online Library account. In the former, there is no threat to life, while in the latter, depending on the extent of the cerebral venous thrombosis, life-threatening medical issues may dominate the picture. Idiopathic intracranial hypertension (IIH) in pregnancy, Heinrich Quincke in 1893 described the first case of elevated intracranial pressure and called it “meningitis serosa.” In 1904 Nonne termed this “pseudo-tumor cerebri.” The term “benign intracranial hypertension” was then coined by Foley in 1955 but subsequently the more descriptive name “idiopathic intracranial hypertension” (IIH) has gained acceptance because of the often non-benign and sometimes significant vision loss that can occur. We also provide assistance, education, and encouragement for individuals … It is a Food and Drug Administration (FDA) category C drug. The brain MRI scan may demonstrate changes suggesting the presence of increased intracranial pressure and can be used to support the diagnosis of IIH. These diseases may present similarly to IIH with headache, nausea and vomiting, neck stiffness, or visual disturbances and therefore need a proper workup[1]. To understand the intrapartum, postpartum and long‐term implications of this condition. 8 comments. There is no increase in maternal, fetal, or neonatal mortality or morbidity in pregnant women diagnosed with IIH. IHer Question: Currently 6 weeks pregnant with IIH, had to stop Diamox and now waiting 3 weeks for my neurologist to guide me to less effective treatment than diamox. The incidence of IIH in women of childbearing age is 0.9/ 100,000. The diagnosis of IIH in pregnancy is the same as in the non-pregnant patient requiring MRI scanning and lumbar puncture. hide. However, the safety of acetazolamide use during human pregnancy remains unclear. It's also called idiopathic intracranial hypertension.Symptoms mimic those of a brain tumor. Close. We studied 109 women with PTC between ages 16 and 44 years. Thirteen women with previous diagnosis of PTC, including two of the aforementioned 11, had an … Both pregnancy and exogenous estrogens are thought to promote or worsen IIH. To identify how idiopathic intracranial hypertension presents in pregnancy. Smith JL. [2] [12]. Magnetic resonance imaging (MRI) and MR venography (MRV) of the brain with and without contrast are the neuroimaging procedure of choice in IIH but gadolinium is not recommended in pregnancy. Posted by 3 hours ago. Federal Register/Vol. Working off-campus? Any chance anyone on here has intracranial hypertension a.k.a pseudo tumor cerebri?? Weight gain is physiologically normal in pregnancy, but too much weight gain can be detrimental. Chung SM: Safety issues in magnetic resonance imaging. Hormones may potentially play a role in the pathophysiology of IIH, however this has not been adequately studied[5]. This page was last modified on January 19, 2021, at 15:22. The increased ICP during labor is not harmful to the mother or the baby because it is transient[5][2]. 73, No. Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without hydrocephalus or mass lesion with elevated cerebrospinal fluid (CSF) pressure but otherwise normal CSF composition (Modified Dandy's criteria). Log in or sign up to leave a comment Log In Sign Up. 1985;5:55–6. Visual loss is the most serious and feared outcome of IIH in both the general population and pregnancy.[6]. Methods Between September 2015 and October 2017, a specialist interest group including neurology, neurosurgery, neuroradiology, ophthalmology, nursing, primary care doctors and patient representatives met. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension. [2]. Additionally, serial lumbar punctures are not well received by many patients. AG. Methods Between September 2015 and October 2017, a specialist interest group including neurology, … 100% Upvoted. The limiting factor in many is the technical difficulty of performing a lumbar puncture in a pregnant woman, especially if she is obese. Opioids are not typically used to treat the headaches in IIH due to risk of fetal dependence and withdrawal symptoms.[1]. Patients with IIH in pregnancy typically have the same evaluation, course, and treatment as non-pregnant patients with IIH but with some exceptions described below. Whence pseudotumor cerebri? It is considered by most experts to be safe in pregnancy. (2019). pregnancy. Headache is the most common presenting symptom usually described as a daily, throbbing, positional headache with nausea and with or without vomiting. 10.1007/978-3-319-98455-1. The increased intracranial pressure can cause swelling of the optic nerve and result in vision loss. [4], There have been several case reports and review articles suggesting pregnancy as a risk factor for IIH. Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, shows a predilection for young, obese women of childbearing age and although no definite association has been found between pregnancy and IIH in case control studies, this condition is an important consideration in pregnant patients – especially as weight gain and increased circulatory volume are normal features of … IIH is a diagnosis of exclusion, therefore when doing a proper workup for suspected IIH, an ophthalmologist should make efforts to exclude other more serious causes of increased intracranial pressure. We report the pregnancy and offspring outcomes in women with intracranial hypertension (IH) treated … Animal studies in rodents has shown a possible relation to limb abnormalities but these have not been reproducible in primates or observed in humans[2]. Thus, it is not surprising that IIH often occurs in pregnancy. It is also important to measure blood pressure to help rule out hypertensive emergency or eclampsia/pre-eclampsia. Two mechanisms that have been postulated are vasogenic extracellular brain edema and a reduced conductance of cerebrospinal fluid outflow at arachnoid villi. Can you still get pregnant with IIH? [3] Therefore, IIH is generally not an indication for medical termination of pregnancy[5]. During delivery no special analgesic requirements are necessary except for epidural anesthesia in patients with a lumboperitoneal shunt, as the anesthesia may move into the peritoneum and not be as effective. It is considered safer than other surgical options in IIH but has yet to be extensively studied in pregnancy. IIH & pregnancy. Landwehr JB, Isada NB, Pryde PG, et al. To know how to monitor and manage women with this condition during pregnancy. Neurology 1984, 34:721–729. In 11, PTC started during pregnancy. A combined spinal epidural analgesia was administered with excellent results. There is no data to demonstrate any adverse effects of MRI in pregnancy, but there are also few studies to prove it is safe. These procedures make a connection from the CSF to the peritoneum to relieve elevated intracranial pressure and therefore treat headaches or visual problems. 61% of cases of IIH occur in the first trimester, although it can occur in any trimester[1]. [2], The majority of IIH patients are child bearing aged females, with a female to male ratio of 8:1. Visual outcomes in women with IIH in pregnancy are the same as non-pregnant women. share. Lee, Andrew & Sinclair, Alexandra & Sadaka, Ama & Berry, Shauna & Mollan, Susan. [2][4], Optic nerve sheath fenestration (ONSF): ONSF is a procedure that involves making a small window in the optic nerve sheath to relieve elevated intracranial pressure. [2], Digre et al. Keywords: Idiopathic intracranial hypertension, Delivery, Obstetric Analgesia Active labor does not place the pregnant woman at an increased risk for vision loss. I know it’s not super common but just thought I’d ask around ♀️ Satti SR, Leishangthem L, Spiotta A, Chaudry MI. Can you share your experience? Steroids: Corticosteroids are considered a category B in terms of fetal risk factor. Opioids are not typically used to treat the headaches in IIH due to risk … Unlimited viewing of the article PDF and any associated supplements and figures. Hi, can you have children with this condition my doc says I would have to come off the diamox which can be distressing and I would have to regular lumbar punctures but doesn't recommend it at the moment. Pseudotumor cerebri (SOO-doe-too-mur SER-uh-bry) occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. 2017;23(2):186–193. Pregnancy has unique and important diagnostic and therapeutic implications for patients with IIH. We evaluated the course, management of pregnant IIH patients and the visual and pregnancy outcomes. [1], IIH is a disease characterized by elevated intracranial pressure and its associated signs and symptoms in an otherwise alert and awake patient, with no apparent cause. reported the prevalence of IIH in pregnancy as 2% to 12%. Analgesics: The use of simple nonsteroidal anti-inflammatory drugs (NSAIDs) are generally safe during pregnancy with the exception of the third trimester due to the risk of premature closure of the fetal ductus arteriosus and oligohydramnios. Idiopathic intracranial hypertension (IIH) is a disease particularly affecting young obese women of child-bearing age. [5], The pathophysiology of IIH with or without pregnancy is still not fully known. Tang RA. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, BJOG: An International Journal of Obstetrics & Gynaecology, International Journal of Gynecology & Obstetrics, Acta Obstetricia et Gynecologica Scandinavica, Australian and New Zealand Journal of Obstetrics and Gynaecology, Journal of Obstetrics and Gynaecology Research, lakshmi.thirumalaikumar@worcsacute.nhs.uk, I have read and accept the Wiley Online Library Terms and Conditions of Use. At the neurology appointment
1 1 month later, the patient was diagnosed with migraine headache syndrome and idiopathic intracranial hypertension (IIH). Thirumalaikumar, L, Ramalingam, K, Heafield, T. Idiopathic intracranial hypertension in pregnancy. Learn about our remote access options, Consultant Obstetrician with special interest in Maternal Medicine, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD UK, Consultant Obstetrician and Gynaecologist, Kingston Hospital, Galsworthy Road, Kingston‐upon‐Thames, Surrey, KT2 7QB UK. Because of this, the use of acetazolamide in pregnancy is often limited to after 20 weeks of gestation after consultation with obstetrics. Computed tomography (CT) could have deleterious effects on the fetus due to ionizing radiation and therefore is not the first choice when evaluating a possible IIH. Management of idiopathic intracranial hypertension in pregnancy. Objective Since idiopathic intracranial hypertension (IIH) is most prevalent in obese women of childbearing age, concerns arise regarding the impact of pregnancy on the disorder and the potential teratogenicity of some therapeutic agents. We studied 109 women with PTC between ages 16 and 44 years. Repeated spinal fluid drainage by LP can be helpful for improvement of symptoms of IIH in pregnancy and preventing permanent vision loss [1,3, 7], as was the case with our patient. We describe the anesthetic management of a parturient with IIH who required multiple lumbar punctures during pregnancy and delivery secondary to worsening neurological symp-toms. Thirteen women with previous diagnosis of PTC, including two of the aforementioned 11, had an … It is a diagnosis of exclusion in a pregnant woman presenting with headache. The Intracranial Hypertension Research Foundation is the only non-profit organization in the world devoted to supporting the medical research of chronic intracranial hypertension. It has also been speculated that polycystic ovarian disease (PCOS) associated with … IIH and Pregnancy? Due to the increased frequency of headaches, pregnancy, and suspicious optic nerves, an urgent consult was placed to neurology. Sort by. Pregnancy occurs in IIH at about the same rate as in the general population and can occur in any trimester of pregnancy. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. The Obstetrician & Gynaecologist 2014; 16: 93– 97. Learn more. The sudden weight gain that accompanies pregnancy and its subsequent weight loss could be an important clue but more research is needed to determine the exact relationship between pregnancy and chronic intracranial hypertension. It is a diagnosis of exclusion in a pregnant woman presenting with headache. In addition, CT is not as sensitive or specific as MRI and MRV in diagnosing intracranial tumors, meningeal disease, and cerebral venous and dural sinus thromboses. Clin Obstet Gynecol. J Clin Neuroophthalmol. Expert opinion: the management of pseudotumor cerebri during pregnancy. It is a diagnosis of exclusion and defined by diagnostic clinical, lumbar puncture, and radiographic criteria. Its use in pregnant women has not been recommended because of reported teratogenic effects in rodents and rabbits. Many neurologic disorders, such as eclampsia, pseudotumor cerebri, stroke, obstetric nerve palsies, subarachnoid hemorrhage, pituitary tumors, and choriocarcinoma, can develop in the pregnant patient. If you do not receive an email within 10 minutes, your email address may not be registered, Serial Lumbar Punctures: Performed 10 days to 2 weeks apart, serial lumbar punctures can help improve headaches. Has anyone been diagnosed with IIH and been pregnant? PCOS, exogeneous estrogen and pregnancy can all worsen IIH. The mode of delivery is usually decided by obstetric factors. Managing IIH in pregnancy. Other symptoms such as pulsatile tinnitus, dizziness, neck pain, back pain, and radicular pain may also be present. Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure with normal CSF composi-tion and no evidence of hydrocephalus or mass lesion. Headache in pregnancy is a particularly important symptom to pay attention to as it may be a sign of a serious and life- threatening diseases such as eclampsia, meningitis, or cerebral venous thrombosis. The incidence in obese women increases to 19.3/100,000. Visual outcome is the same for nonpregnant patients with IIH. 2005;7(4):40. This risk needs to be communicated with the patient. Diuretics: Acetazolamide is the most common diuretic used to treat IIH. Serial lumbar punctures may however be an option in the pregnant patient who fails or refuses medical therapy and wishes to delay or avoid surgery. [2], The signs and symptoms of IIH in pregnancy are similar to the signs and symptoms in the non-pregnant population. [9], Analgesics: The use of simple nonsteroidal anti-inflammatory drugs (NSAIDs) are generally safe during pregnancy with the exception of the third trimester due to the risk of premature closure of the fetal ductus arteriosus and oligohydramnios. Please check your email for instructions on resetting your password. 3. Interv Neuroradiol. Idiopathic intracranial hypertension (IIH) affects women more than men and especially young obese women of reproductive age. Background: Acetazolamide is the mainstay of medical therapy for idiopathic intracranial hypertension (IIH). It is a carbonic anhydrase inhibitor that reportedly decreases CSF production. However, IIH in pregnancy occurs at the same rate as the general population, therefore, pregnancy is not considered an etiologic factor and might be better explained by the weight gain that occurs normally in pregnancy and that IIH occurs predominantly in women of childbearing age. save. It is important to understand the medical and surgical treatment options in pregnancy. The diagnosis of IIH in pregnancy (as well as in non-pregnant patients) is made by using the modified Dandy Criteria: (1) increased intracranial pressure and associated symptoms, (2) without localizing neurological findings, (3) patient is alert and oriented, (4) normal neurodiagnostic studies except for increased CSF pressure and (5) no other cause of increased ICP is present.[7]. Obstet Gynecol 1994, 83:134–137. Can you still have children with IIH? Additionally, visual outcomes for IIH in pregnancy are believed to be the same as for non-pregnant IIH patients. Neuro-Ophthalmology Global Trends in Diagnosis, Treatment and Management: Global Trends in Diagnosis, Treatment and Management. Pseudotumor cerebri (PTC) is most commonly seen in obese women of reproductive age. A full eye exam including dilated fundus exam is recommended to detect papilledema. The prognosis for pregnant women with IIH is excellent for both mother and child. There are limited data to support the safety and effectiveness of CSF diversion procedures in pregnancy, however, the data that is available suggests lumboperitoneal shunts are not contraindicated in pregnancy and can be safe for both mother and fetus. Digre KB, Varner MW, Corbett JJ: Pseudotumor cerebri and pregnancy. 104/Thursday, May 29, 2008. There is little literature that defines a “healthy” amount of weight gain in pregnant patients with IIH. Formal visual field testing is also recommended to assess baseline and follow patients for the development of vision loss which is the most feared complication of IIH. Idiopathic intracranial hypertension is a rare condition that usually affects overweight women. It may be important, however, for obstetrics to check the blood pressure as well as routine monitoring of urine protein, complete blood counts (CBC), serum creatinine, and liver function testing (LFT). Methods Case series of pregnant women diagnosed with IIH. [11] ONSF is typically reserved for patients with moderate to severe or progressive visual loss in a patient who has failed or is unable to receive medical therapy. Do we need a high index of suspicion in all pregnant women presenting with headache? An initial UK survey of attitudes and practice J Neuro-ophthalmol 2002, 22:35–39. Huna-Baron, R. & Kupersmith, M. J Neurol (2002) 249: 1078. The aim was to capture interdisciplinary expertise from a large group of clinicians, reflecting practice from across the UK and further, to inform subsequent development of a national consensus guidance for optimal management of idiopathic intracranial hypertension (IIH). MedGenMed. It is seen predominantly in overweight women of childbearing age. The risk of visual impairment is the same in pregnant and non‐pregnant women with idiopathic intracranial hypertension. IIH is a disease of unknown etiology. Unlimited viewing of the article/chapter PDF and any associated supplements and figures. Published 2005 Nov 10. Evans RW, Friedman DI. [1], It is important to calculate body mass index (BMI) as obesity is a risk factor for IIH. 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