Management of idiopathic intracranial hypertension in parturients: anesthetic considerations

Abstract

Although IIH is rare, there are special considerations for anesthetic management in the parturient. Despite the presence of raised ICP in these patients, there are no specific contraindications to neuraxial techniques, and uncal herniation has not been reported to occur in patients with IIH.

Clinical Management of Delivery in Pregnant Woman with Idiopathic Intracranial Hypertension

“…Serial explorations of the ocularfundus were necessary to objectify the ophthalmic repercussion [1] If it had been affected, lumbar punctures could have been performed, even repeated [1,3,7] .…”

“…Spinal fluid extraction does not present an increased risk of transforaminal herniation [3] , in fact, the treatment consists of punctures to drain CSF. In the literature we see good management with spinal epidural combined technique [9] , so was the choice, although it is more complex from the technical point of view.…”

“…In short, the management of pregnancy and labor in patients with Idiopathic Intracranial Hypertension aims to minimize the uncontrolled increase in ICP with mainly consequences visually [3] . This is accomplished with a multidisciplinary approach involving the obstetrician, neurologist, anesthesiologist and ophthalmologist [6] .…”

“…A lesion of spatial occupation must be previously ruled out by imaging. The usual medical treatment is based on analgesics, corticosteroids, carbonic anhydrase inhibitors and diuretics (acetazolamide); if adequate control is not achieved are indicated lumbar punctures for extracting CSF [1,2,3] .…”

“…Uncontrolled intracranial hypertension required to end the pregnancy by the quickest route, either through induction or cesarean section. In other cases, the indication is only by obstetrical reasons [3,5,6] .…”