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 evaluated the course, management of pregnant IIH patients and the visual and pregnancy outcomes. Methods Case series of pregnant women diagnosed with IIH. IIH symptoms, neuro-ophthalmological findings, IIH management, visual and pregnancy outcomes were documented. Results Among 240 women with IIH, 12 had 16 pregnancies. Ten had headaches, five had transient visual obscurations, and three had diplopia. Visual acuity was severely decreased in one and mildly reduced in three women. Six had marked and six had mild bilateral papilledema. Visual field loss occurred in four women. Visual symptoms and loss improved for the duration of the pregnancy after diagnostic lumbar puncture and salt restricted diet in three. Two additional women needed continuous spinal drainage for two days. One woman was treated with acetazolamide and medical abortion. The one woman with severe vision loss had fenestration of one optic nerve sheath and a lumboperitoneal shunt as well as corticosteroids and was the only case with permanent field loss. After intervention, visual acuity improved in all cases with reduced vision. There were 10 full-term normal deliveries, three missed abortions, one therapeutic abortion and two intrauterine fetal deaths. Conclusions IIH appears to present during the first two trimesters of pregnancy with typical symptoms and findings. Visual outcome is similar as for non-pregnant women. Treatment should be oriented towards dietary control, without ketosis. Repeated spinal fluid drainage, if needed, can be helpful.