Introduction: The management of patients with Idiopathic Intracranial Hypertension (IIH) includes neuro-ophthalmologic evaluations, weight management, medications, optic nerve sheath fenestrations, venous sinus stentings, temporal decompressions, and CSF diversions. 90% of patients are women of childbearing age. Pregnancy poses certain dietary, medical and radiological limitations for management. We present a case series of IIH patients successfully managed through their pregnancy, and the various management techniques utilized.

Methods: IIH patients who required CSF diversion interventions before or during pregnancy from 2014 through 2015 were reviewed. The methods of management are described here.

Results: Fifteen patients were identified during the two years reviewed as pregnant with IIH, whose IIH required some form of CSF diversion. Seven were diagnosed with IIH prior and had shunts in place during their pregnancies. Of these, 5 were lumbo-peritoneal (LPS) and 2 were ventriculo-peritoneal (VPS) shunts. One patient required revision during pregnancy (LPS) and one required serial ultrasound guided lumbar punctures (USGLP) during pregnancy with shunt revision postpartum (LPS). Four were diagnosed with IIH during pregnancy and underwent shunt placement (3 VJS and 1 LPS) due to rapid visual loss despite lumbar punctures and medical management. Four were managed with ultrasound guided lumbar punctures (USGLP) alone, three patients with known IIH and one first diagnosed during pregnancy.

Conclusions: The management of IIH in pregnancy requires frequent neuro-ophthalmologic evaluation and individual assessment of patient needs, depending on the severity of visual threat and understanding the limitations of medical and dietary management. Most patients with shunts will not need interventions during their pregnancies. Surgery may be performed successfully and safely in those with significant visual threat. VP shunts are a reasonable choice. The Ultrasound Guided Lumbar Puncture (USGLP) is a successful adjunct for CSF diversion in these patients where fluoroscopy is contraindicated.

Patient Care: Expand the successful treatment options available to physicians for consideration in pregnant patients with IIH.

Learning Objectives: 1. Describe the options for management of pregnant patients with idiopathic intracranial hypertension.

References: Kesler A, Kupferminc M. (2013). Idiopathic intracranial hypertension and pregnancy. Clinical Obstetrics and Gynecology, 56(2), 389-396. Karmaniolou I, Petropoulos G, & Theodoraki K (2011). Management of idiopathic intracranial hypertension in parturients: Anesthetic considerations. Canadian Journal of Anesthesia, 58, 650-657. Huna-Baron R, Kupersmith M (2002). Idiopathic intracranial hypertension in pregnancy. Journal of Neurolgy, 249, 1078-1081. Lee A, Pless M, Falardeau J, Capozzoli T, Wall M, Kardon R (2005). The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. American Journal of Ophthalmology, 139(5), 855-859. Evans R, Lee A (2010). Idiopathic intracranial hypertension in pregnancy. Headache, 50, 1513-1515. Tang R, Dorotheo E, Schiffman J, Bahrani H (2004). Medical and surgical management of idiopathic intracranial hypertension in pregnancy. Current Neurology and Neuroscience Reports, 4(5), 398-409. Digre K, Varner M, Corbett J (1984). Pseudotumor cerebri and pregnancy. Neurology, 34, 721-9.