Management of idiopathic intracranial hypertension in parturients: anesthetic considerations

Abstract

Idiopathic intracranial hypertension (IIH) is a rare condition characterized by raised intracranial pressure (ICP) without related pathology in either the brain or the composition of cerebrospinal fluid (CSF). Herein, we provide a brief review of the clinical presentation of IIH and the anesthetic considerations in parturients diagnosed with the disorder. We conducted a MEDLINE® literature search for all types of articles published in English with restriction for year of publication, and we used the search terms "idiopathic intracranial hypertension", "pseudotumor cerebri", "benign intracranial hypertension", "pregnancy", "cesarean section", "labour analgesia", "epidural", and "anesthesia". Idiopathic intracranial hypertension affects primarily obese women of childbearing age. The main symptom is headache, and the cardinal sign is papilledema. The main goal of management is to preserve visual function. Treatment lies in the administration of diuretics and corticosteroids, control of excessive weight gain, and surgical management, such as cerebrospinal fluid diversion or optic nerve sheath fenestration for refractory cases. For the parturient with IIH, Cesarean delivery is not necessarily indicated. Neuraxial anesthesia has been used uneventfully for both labour analgesia and for Cesarean delivery. There are reports describing successful use of both spinal and epidural anesthesia, even in IIH patients with CSF diversion devices in situ. 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.