Idiopathic Intracranial Hypertension and Pregnancy

Kesler, Anat; Kupferminc, Michael J.

doi:10.1097/grf.0b013e31828f2701

Cited by 62 publications

(73 citation statements)

References 19 publications

(44 reference statements)

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“…Pregnancy is not considered to be a risk factor for IIH, however in pregnant patients with co-existing conditions such as being a recipient of renal transplant, IHH could be more prevalent [17][18][19][20][21]. Therefore, there should be a high index of suspicion for IHH in patients with persistent headaches and rapid visual loss.…”

Section: Discussionmentioning

confidence: 99%

Ventriculoperitoneal shunt treatment in a pregnant renal transplant recipient with idiopathic intracranial hypertension: Case report and review of the literature

Doğan

Göksu

et al. 2018

Neurologia i Neurochirurgia Polska

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Idiopathic intracranial hypertension (IIH) is a relatively uncommon disorder characterised by raised intracranial pressure without an established pathogenesis. Diagnosis of IIH requires the demonstration of symptoms and signs referable only to elevated intracranial pressure; cerebrospinal fluid (CSF) opening pressure >25cm HO measured in the lateral decubitus position; normal CSF composition; and no evidence for an underlying structural cause demonstrated by using MRI or contrast-enhanced CT scan for typical patients and MRI and MR venography for atypical patients such as man, children and those with low body mass index. We present a 38-year old primigravid renal transplant patient at 7 weeks of gestation who presented with 2 weeks of intense, throbbing, holocranial headache, nausea, vomiting, photophobia, diplopia and progressive visual loss. When medical treatment fails and/or not appropriate to use due to the reported of teratogenic risks in pregnant women, surgical interventions gain importance. In this particular patient, venticuloperitoneal shunt was chosen as the CSF diversion technique. In this case report indications, contraindications in addition to outcomes regarding headache, vision loss and the resolution of papilloedema of the present surgery options for IIH are discussed.

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Section: Discussionmentioning

confidence: 99%

Ventriculoperitoneal shunt treatment in a pregnant renal transplant recipient with idiopathic intracranial hypertension: Case report and review of the literature

Doğan

Göksu

et al. 2018

Neurologia i Neurochirurgia Polska

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“…25,26 Gonadal hormones also may contribute to the pathogenesis of IIH, particularly in the early and late adolescent, and more likely pubertal, age groups. Indeed, exposure to exogenous (e.g., levonorgestrel 27 and emergency contraceptives 28 ) and endogenous (e.g., pregnancy 29,30 and polycystic ovary syndrome 31 ) estrogens have been associated with IIH. Moreover, increased androgens, namely basal testosterone and androstenedione, have been linked with a younger age at presentation of IIH in an adult female population.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Idiopathic Intracranial Hypertension

et al. 2016

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Purpose To examine anthropometric and maturational characteristics at diagnosis in pediatric idiopathic intracranial hypertension (IIH). Design Retrospective, international, multisite study. Participants Pediatric patients (2–18 years of age at diagnosis) with IIH. Main Outcome Measures Body mass index (BMI), height, and weight Z-scores; sexual maturation. Methods Cases of IIH were identified retrospectively based on diagnostic code, pediatric neuroophthalmologist databases, or both and updated diagnostic criteria (2013) were applied to confirm definite IIH. Anthropometric measurements were converted into age- and gender-specific height, weight, and BMI Z-scores CDC 2000 growth charts. When available, sexual maturation was noted. Results Two hundred thirty-three cases of definite IIH were identified across 8 sites. In boys, a moderate association between age and BMI Z-scores was noted (Pearson’s correlation coefficient, 0.50; 95% confidence interval [CI], 0.30–0.66; P < 0.001; n = 72), and in girls, a weak association was noted (Pearson’s correlation coefficient, 0.34; 95% CI, 0.20–0.47; P < 0.001; n = 161). The average patient was more likely to be overweight at diagnosis at age 6.7 years in girls and 8.7 years in boys, and obese at diagnosis at age 12.5 years in girls and 12.4 years in boys. Compared with age- and gender-matched reference values, early adolescent patients were taller for age (P = 0.002 in girls and P = 0.02 in boys). Data on Tanner staging, menarchal status, or both were available in 25% of cases (n = 57/233). Prepubertal participants (n = 12) had lower average BMI Z-scores (0.95±1.98) compared with pubertal participants (n = 45; 1.92±0.60), but this result did not reach statistical significance (P = 0.09). Conclusions With updated diagnostic criteria and pediatric-specific assessments, the present study identifies 3 subgroups of pediatric IIH: a young group that is not overweight, an early adolescent group that is either overweight or obese, and a late adolescent group that is mostly obese. Data also suggest that the early adolescent group with IIH may be taller than age- and gender-matched reference values. Understanding these features of pediatric IIH may help to illuminate the complex pathogenesis of this condition.

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“…However, caution may be needed with labor anesthesia for patients with a lumboperitoneal shunt because the anesthetic may flow from the subarachnoid spaces into the peritoneal cavity, leading to insufficient analgesia. 82 Regarding the treatment of IIH during pregnancy, acetazolamide appears safe in humans 83 and we continue it if the patient has any degree of significant visual loss with permission of the patient's obstetrician. If the patient has only mild or no visual loss, we will frequently stop the acetazolamide during the first trimester and follow the patient closely.…”

Section: Idiopathic Intracranial Hypertension and Pregnancymentioning

confidence: 99%

Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

Bidot

2015

Semin Neurol

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Idiopathic intracranial hypertension (IIH) is a rare disorder occurring more frequently in obese women of childbearing age, resulting in increased intracranial pressure (ICP) from an unknown cause. Recent advances in epidemiology, imaging, and treatment have provided a better understanding of IIH in recent years, with better identification of visual risk factors and atypical forms of IIH, including fulminant IIH and spontaneous cerebrospinal fluid leaks, and a randomized clinical trial providing the rationale for the use of acetazolamide. In addition, a revised version of the modified Dandy criteria for the diagnosis of IIH was suggested in 2013, with better definition of IIH in adults and children; however, controversy regarding nomenclature has precluded its acceptance among IIH experts. Finally, questions regarding the best surgical strategy, the indications for venous sinus stenting, and the diagnostic role of the radiologic findings commonly seen in IIH have remained unanswered.

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Idiopathic Intracranial Hypertension and Pregnancy

Cited by 62 publications

References 19 publications

Ventriculoperitoneal shunt treatment in a pregnant renal transplant recipient with idiopathic intracranial hypertension: Case report and review of the literature

Ventriculoperitoneal shunt treatment in a pregnant renal transplant recipient with idiopathic intracranial hypertension: Case report and review of the literature

Pediatric Idiopathic Intracranial Hypertension

Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

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