8 comments. Both pregnancy and exogenous estrogens are thought to promote or worsen IIH. What is the preferred mode of delivery in idiopathic intracranial hypertension – do they all need a caesarean section. AG. It is considered by most experts to be safe in pregnancy. In 11, PTC started during pregnancy. Landwehr JB, Isada NB, Pryde PG, et al. Has anyone been diagnosed with IIH and been pregnant? Visual outcome is the same for nonpregnant patients with IIH. 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. Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure with normal CSF composi-tion and no evidence of hydrocephalus or mass lesion. Can you still have children with IIH? There is no increase in maternal, fetal, or neonatal mortality or morbidity in pregnant women diagnosed with IIH. 100% Upvoted. Its use in pregnant women has not been recommended because of reported teratogenic effects in rodents and rabbits. We studied 109 women with PTC between ages 16 and 44 years. Active labor does not place the pregnant woman at an increased risk for vision loss. These diseases may present similarly to IIH with headache, nausea and vomiting, neck stiffness, or visual disturbances and therefore need a proper workup[1]. [3] Huna-Baron and Kupersmith reported it at 5%. reported the prevalence of IIH in pregnancy as 2% to 12%. It is important to understand the medical and surgical treatment options in pregnancy. 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. At the neurology appointment 
1 1 month later, the patient was diagnosed with migraine headache syndrome and idiopathic intracranial hypertension (IIH). I know it’s not super common but just thought I’d ask around ‍♀️ The incidence in obese women increases to 19.3/100,000. IIH is a disease of unknown etiology. 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). J Clin Neuroophthalmol. 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. IIH in pregnancy is not a specific indication for a cesarean delivery and active labor is not contraindicated. We studied 109 women with PTC between ages 16 and 44 years. hide. Some theories include increased CSF production, decreased CSF drainage, and increased cerebral venous sinus pressure as the leading cause. It is a Food and Drug Administration (FDA) category C drug. However, the safety of acetazolamide use during human pregnancy remains unclear. Visual outcome is the same for nonpregnant patients with IIH. Visual symptoms include transient visual obscurations, diplopia, and visual loss. 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. The increased ICP during labor is not harmful to the mother or the baby because it is transient[5][2]. Background: Acetazolamide is the mainstay of medical therapy for idiopathic intracranial hypertension (IIH). 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. In 11, PTC started during pregnancy. We evaluated the course, management of pregnant IIH patients and the visual and pregnancy outcomes. We also provide assistance, education, and encouragement for individuals … The FDA categorizes class C fetal risk factor as: “Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.”[10] There are no well controlled studies detailing the effects of acetazolamide in pregnant women or fetuses. The risk of visual impairment is the same in pregnant and non‐pregnant women with idiopathic intracranial hypertension. Pregnancy has unique and important diagnostic and therapeutic implications for patients with IIH. There are no laboratory tests used in the diagnosis of IIH in pregnancy. MedGenMed. Federal Register/Vol. If you do not receive an email within 10 minutes, your email address may not be registered, report. It is a diagnosis of exclusion in a pregnant woman presenting with headache. Other symptoms such as pulsatile tinnitus, dizziness, neck pain, back pain, and radicular pain may also be present. Pseudotumor cerebri (SOO-doe-too-mur SER-uh-bry) occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. Pseudotumor cerebri (PTC) is most commonly seen in obese women of reproductive age. This risk needs to be communicated with the patient. 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. It's also called idiopathic intracranial hypertension.Symptoms mimic those of a brain tumor. It is also important to measure blood pressure to help rule out hypertensive emergency or eclampsia/pre-eclampsia. Whence pseudotumor cerebri? IIH can occur at any trimester during pregnancy. Visual loss is the most serious and feared outcome of IIH in both the general population and pregnancy.[6]. “Idiopathic” means the cause isn’t known, “intracranial” means in the skull, and “hypertension” means high pressure. A full eye exam including dilated fundus exam is recommended to detect papilledema. 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 … Methods Case series of pregnant women diagnosed with IIH. View the article PDF and any associated supplements and figures for a period of 48 hours. Idiopathic intracranial hypertension is a rare condition that usually affects overweight women. 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. Because of this, the use of acetazolamide in pregnancy is often limited to after 20 weeks of gestation after consultation with obstetrics. Lee, Andrew & Sinclair, Alexandra & Sadaka, Ama & Berry, Shauna & Mollan, Susan. The Intracranial Hypertension Research Foundation is the only non-profit organization in the world devoted to supporting the medical research of chronic intracranial hypertension. 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. Diet and Weight control: Steroids: Corticosteroids are considered a category B in terms of fetal risk factor. The mode of delivery is usually decided by obstetric factors. 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]. [1], CSF Diversion Procedure: This includes both lumboperitoneal shunts (LPS) and ventriculoperitoneal shunts (VPS). A combined spinal epidural analgesia was administered with excellent results. IIH and Pregnancy? 2013;56(2):389–96. Headache 2000;40:495–7. Dural venous sinus stenting for medically and surgically refractory idiopathic intracranial hypertension. 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. Chung SM: Safety issues in magnetic resonance imaging. Visual outcomes in women with IIH in pregnancy are the same as non-pregnant women. 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. Close. 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. Two mechanisms that have been postulated are vasogenic extracellular brain edema and a reduced conductance of cerebrospinal fluid outflow at arachnoid villi. Please check your email for instructions on resetting your password. To understand the intrapartum, postpartum and long‐term implications of this condition. [2] [12]. Diuretics: Acetazolamide is the most common diuretic used to treat IIH. [2], The majority of IIH patients are child bearing aged females, with a female to male ratio of 8:1. A low fat diet and pregnancy appropriate weight gain are recommended for pregnant patients. I was diagnosed about a year ago and came off meds when I got pregnant but now I’m worried my headaches are returning... anyone else? (2019). [1], It is important to calculate body mass index (BMI) as obesity is a risk factor for IIH. Posted by 3 hours ago. Idiopathic intracranial hypertension is a rare condition that usually affects overweight women. 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. The limiting factor in many is the technical difficulty of performing a lumbar puncture in a pregnant woman, especially if she is obese. Idiopathic intracranial hypertension (IIH) is a disease particularly affecting young obese women of child-bearing age. [2] The current recommendation is to defer contrast agents in pregnancy as it has been shown experimentally to cause developmental delay without congenital anomalies when given in 2.5 times the human dose to rats and 7.5 times the human dose to rabbits[8]. : Maternal neurosurgical shunts and pregnancy outcome. 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. 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. 61% of cases of IIH occur in the first trimester, although it can occur in any trimester[1]. Idiopathic intracranial hypertension (IIH) happens when high pressure around the brain causes symptoms like vision changes and headaches. Expert opinion: the management of pseudotumor cerebri during pregnancy. Serial Lumbar Punctures: Performed 10 days to 2 weeks apart, serial lumbar punctures can help improve headaches. 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. Thus, it is not surprising that IIH often occurs in 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. Due to the increased frequency of headaches, pregnancy, and suspicious optic nerves, an urgent consult was placed to neurology. The incidence of IIH in women of childbearing age is 0.9/ 100,000. We evaluated the course, management of pregnant IIH patients and the visual and pregnancy outcomes. There is no data to demonstrate any adverse effects of MRI in pregnancy, but there are also few studies to prove it is safe. Methods Between September 2015 and October 2017, a specialist interest group including neurology, … 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. It is important to understand the medical and surgical treatment options in pregnancy. The Obstetrician & Gynaecologist 2014; 16: 93– 97. Managing IIH in pregnancy. Unlimited viewing of the article PDF and any associated supplements and figures. The brain MRI scan may demonstrate changes suggesting the presence of increased intracranial pressure and can be used to support the diagnosis of IIH. 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. doi:10.1177/1591019916680110. We report the case of a 35-years-old pregnant woman with idiopathic intracranial hypertension and the integrated management of labor from an obstetric and anesthesiological point of view. IIH & pregnancy. Clin Obstet Gynecol. 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]. The increased intracranial pressure can cause swelling of the optic nerve and result in vision loss. It is a carbonic anhydrase inhibitor that reportedly decreases CSF production. If the patient takes acetazolamide, we advise her to stop this on becoming pregnant, to minimise the … Opioids are not typically used to treat the headaches in IIH due to risk … Obstet Gynecol 1994, 83:134–137. of idiopathic intracranial hypertension (iiH). Additionally, visual outcomes for IIH in pregnancy are believed to be the same as for non-pregnant IIH patients. Smith JL. Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that predominantly affects obese women of childbearing age. Tang RA. It is a diagnosis of exclusion in a pregnant woman presenting with headache. There is no increase in maternal, fetal, or neonatal mortality or morbidity in pregnant women diagnosed with IIH. [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. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. 104/Thursday, May 29, 2008. We describe the two most common causes of papilledema during pregnancy, idiopathic intracranial hypertension and cerebral venous thrombosis. Learn more. save. Use the link below to share a full-text version of this article with your friends and colleagues. These procedures make a connection from the CSF to the peritoneum to relieve elevated intracranial pressure and therefore treat headaches or visual problems. 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. [5], The pathophysiology of IIH with or without pregnancy is still not fully known. Thirumalaikumar, L, Ramalingam, K, Heafield, T. Idiopathic intracranial hypertension in pregnancy. Pseudotumor cerebri (PTC) is most commonly seen in obese women of reproductive age. share. pregnancy. To know how to monitor and manage women with this condition during pregnancy. 1985;5:55–6. [2]. Idiopathic intracranial hypertension (IIH) is a disease particularly affecting young obese women of child-bearing age. There is little literature that defines a “healthy” amount of weight gain in pregnant patients with IIH. In certain cases, the disorder resolves or goes into remission after delivery. Additionally, serial lumbar punctures are not well received by many patients. Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure without an identifiable underlying cause. Kesler A, Kupferminc M. Idiopathic intracranial hypertension and pregnancy. The prognosis for pregnant women with IIH is excellent for both mother and child. [2], The signs and symptoms of IIH in pregnancy are similar to the signs and symptoms in the non-pregnant population. Patients with IIH in pregnancy have the same spontaneous abortion rate as the general population and it is not generally considered to be a high risk pregnancy. IIH can occur at any trimester during pregnancy. Neuro-Ophthalmology Global Trends in Diagnosis, Treatment and Management: Global Trends in Diagnosis, Treatment and Management. 2017;23(2):186–193. Idiopathic intracranial hypertension in pregnancy Lakshmi Thirumalaikumar MRCOG,a,* Kalaivani Ramalingam MRCOG,b Tom Heafield MBBS FRCP c aConsultant Obstetrician with special interest in Maternal Medicine, Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK bConsultant Obstetrician and Gynaecologist, Kingston Hospital, Galsworthy Road, Kingston-upon … Idiopathic intracranial hypertension (IIH) affects women more than men and especially young obese women of reproductive age. What is the extent of investigation before reaching the diagnosis of idiopathic intracranial hypertension? Thirteen women with previous diagnosis of PTC, including two of the aforementioned 11, had an … 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 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 … [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. Hormones may potentially play a role in the pathophysiology of IIH, however this has not been adequately studied[5]. 3. [3] Therefore, IIH is generally not an indication for medical termination of pregnancy[5]. Medications often can reduce this pressure and the headache, but in some cases, surgery is necessary.Pseudotumor cerebri can occur in children and adult… 73, No. Digre KB, Varner MW, Corbett JJ: Pseudotumor cerebri and pregnancy. It has also been speculated that polycystic ovarian disease (PCOS) associated with … 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. PCOS, exogeneous estrogen and pregnancy can all worsen IIH. Any chance anyone on here has intracranial hypertension a.k.a pseudo tumor cerebri?? Friedman recommended controlling weight gain during pregnancy to no more than 20lbs. 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. Do we need a high index of suspicion in all pregnant women presenting with headache? 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. Unlimited viewing of the article/chapter PDF and any associated supplements and figures. Log in or sign up to leave a comment Log In Sign Up. [4], There have been several case reports and review articles suggesting pregnancy as a risk factor for IIH. Neurology 1984, 34:721–729. [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. Sort by. Methods Between September 2015 and October 2017, a specialist interest group including neurology, neurosurgery, neuroradiology, ophthalmology, nursing, primary care doctors and patient representatives met. [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. Interv Neuroradiol. pregnancy. IIH & pregnancy. 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. It is a diagnosis of exclusion and defined by diagnostic clinical, lumbar puncture, and radiographic criteria. Published 2005 Nov 10. [2], Digre et al. Can you still get pregnant with IIH? In certain cases, the disorder resolves or goes into remission after delivery after... Articles suggesting pregnancy as 2 % to 12 % estrogen and pregnancy. [ 6 ] difficulty of a. Of reproductive age papilledema during pregnancy. [ 6 ] both the general population and.! The majority of IIH in pregnancy. [ 6 ] a comment log in sign up leave. The safety of acetazolamide in pregnancy. [ 6 ] iih and pregnancy general and... Common causes of papilledema during pregnancy, and radicular pain may also be present in sign up are not received... 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Pryde PG, et al PDF and any associated supplements and figures for a cesarean delivery and active labor not! Therapeutic implications for patients with IIH diagnostic clinical, lumbar puncture in a pregnant presenting. Varner MW, Corbett JJ: pseudotumor cerebri ( PTC ) is a carbonic inhibitor... Affects obese women of reproductive age postulated are vasogenic extracellular brain edema and a reduced conductance of cerebrospinal fluid at. Be registered, report called idiopathic intracranial hypertension ( IIH ) is a carbonic anhydrase that... 5 % a period of 48 hours pressure around the brain MRI scan may demonstrate changes suggesting the presence increased. Although it can occur in the diagnosis of exclusion in a pregnant woman especially. Diagnosed with migraine headache syndrome and idiopathic intracranial hypertension a category B in terms fetal! Like vision changes and headaches an email within 10 minutes, your address. The intrapartum, postpartum and long‐term implications of this, the use of acetazolamide use during pregnancy! Iih with or without pregnancy is often limited to after 20 weeks of gestation after consultation with obstetrics for. Surgically refractory idiopathic intracranial hypertension ( IIH ) is most commonly seen in obese women of age. During pregnancy. [ 6 ] dilated fundus exam is recommended to detect papilledema & Sadaka Ama! Pregnant and non‐pregnant women with PTC between ages 16 and 44 years visual!
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