Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Narrative Review

Multidisciplinary management of idiopathic intracranial hypertension in pregnancy: case series and narrative review

Sara Alves, Natacha Sousa, Luísa Cardoso, Joana Alves

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Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by raised intracranial pressure of unknown etiology with normal cerebrospinal fluid (CSF) composition and no brain lesions. It occurs in pregnant patients at approximately the same frequency as in general population, but obstetric and anesthetic management of the pregnancy and labor remains controversial. In this article we provide a multidisciplinary review of the main aspects of IIH in pregnancy including treatment options, mode of delivery and anesthetic techniques. Additionally, we report three cases of pregnant women diagnosed with IIH between 2012 and 2019 in our institution.


Idiopathic intracranial hypertension;  Pregnancy;  Cesarean section;  Labor analgesia’;  Anesthesia


[1] I. Karmaniolou, G. Petropoulos, K. Theodoraki Management of idiopathic intracranial hypertension in parturients: anesthetic considerations Can J Anesth Can d’anesthésie., 58 (2011), p. 650

[2] R. Huna-Baron, M.J. Kupersmith Idiopathic intracranial hypertension in pregnancy J Neurol., 249 (2002), pp. 1078-1081

[3] R.A. Tang, E.U. Dorotheo, J.S. Schiffman, et al. Medical and surgical management of idiopathic intracranial hypertension in pregnancy Curr Neurol Neurosci Rep., 4 (2004), pp. 398-409

[4] R.W. Evans, D.I. Friedman The management of pseudotumor cerebri during pregnancy Headache., 40 (2000), pp. 495-497

[5] A. Kesler, M. Kupferminc Idiopathic intracranial hypertension and pregnancy Clin Obstet Gynecol., 56 (2013), pp. 389-396

[6] D.I. Friedman, G.T. Liu, K.B. Digre Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children Neurology., 81 (2013), pp. 1159-1165

[7] S.M. Chung Safety issues in magnetic resonance imaging J Neuro-Ophthalmology., 22 (2002), pp. 35-39

[8] R. Bagga, V. Jain, C.P. Das, et al. Choice of therapy and mode of delivery in idiopathic intracranial hypertension during pregnancy Med Gen Med., 7 (2005), p. 42

[9] M. Wall Sensory visual testing in idiopathic intracranial hypertension: Measures sensitive to change Neurology., 40 (1990), p. 1859

[10] V. Biousse, B.B. Bruce, N.J. Newman Update on the pathophysiology and management of idiopathic intracranial hypertension J Neurol Neurosurg Psychiatry., 83 (2012), pp. 488-494

[11] A.G. Lee, M. Pless, J. Falardeau, et al. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy Am J Ophthalmol., 139 (2005), pp. 855-859

[12] J. Falardeau, B.M. Lobb, S. Golden, et al. The use of acetazolamide during pregnancy in intracranial hypertension patients J Neuro-Ophthalmology., 33 (2013), pp. 9-12

[13] J.J. Corbett, H.S. Thompson The rational management of idiopathic intracranial hypertension Arch Neurol., 46 (1989), pp. 1049-1051

[14] P. Guerci, F. Vial, U. McNelis, et al. Neuraxial anesthesia in patients with intracranial hypertension or cerebrospinal fluid shunting systems: What should the anesthetist know? Minerva Anestesiol., 80 (2014), pp. 1030-1045

[15] G. Kuba, P. Kroll Geburtsleitung und Indikationen zur Interruptio und Sectio caesarea bei Augenerkrankungen - eine Übersicht Klin Monbl Augenheilkd., 211 (1997), pp. 349-353

[16] D.M. Moore, M. Meela, D. Kealy, et al. An intrathecal catheter in a pregnant patient with idiopathic intracranial hypertension: analgesia, monitor and therapy? Int J Obstet Anesth., 23 (2014), pp. 175-178

[17] J.A. Anson, S. Vaida, D.M. Giampetro, et al. Anesthetic management of labor and delivery in patients with elevated intracranial pressure Int J Obstet Anesth., 24 (2015), pp. 147-160

[18] H. van Crevel, A. Hijdra, J. de Gans Lumbar puncture and the risk of herniation: when should we first perform CT? J Neurol., 249 (2002), pp. 129-137

[19] M. Pérez Rodríguez, J. de Carlos Errea, M. Dorronsoro Auzmendi, et al. Hipertensión intracraneal idiopática: Cesárea con anestesia epidural tras normalización de la presión del líquido cefalorraquídeo Rev Esp Anestesiol Reanim., 60 (2013), pp. 594-596

[20] L. Leffert Neuraxial Anesthesia in Parturients with Intracranial Pathology Anesthesiology., 119 (2013), pp. 703-718

[21] B. Butala, V. Shah Anaesthetic management of a case of idiopathic intracranial hypertension Indian J Anaesth., 57 (2013), p. 401

[22] J. Heckathorn, J.P. Cata, S. Barsoum Intrathecal anesthesia for cesarean delivery via a subarachnoid drain in a woman with benign intracranial hypertension Int J Obstet Anesth., 19 (2010), pp. 109-111

[23] C.R. Bedson, F. Plaar, et al. Benign intracranial hypertension and anaesthesia for caesarean section Int J Obstet Anesth., 8 (1999), pp. 288-290

[24] E.E. Aly, B.K. Lawther Anaesthetic management of uncontrolled idiopathic intracranial hypertension during labour and delivery using an intrathecal catheter Anaesthesia., 62 (2007), pp. 178-181

[25] F.S. Gragasin, A.B. Chiarella Use of an Intrathecal Catheter for Analgesia Anesthesia, and Therapy in an Obstetric Patient with Pseudotumor Cerebri Syndrome A case reports., 6 (2016), pp. 160-162

[26] F. Worsham, E. Beckman, C. Mitchell Sacrococcygeal teratoma in a neonate: association with maternal use of acetazolamide JAMA., 240 (1978), pp. 251-252

[27] P. Havránek, H. Hedlund, A. Rubenson, et al. Sacrococcygeal teratoma in Sweden between 1978 and 1989: Long-term functional results J Pediatr Surg., 27 (1992), pp. 916-918

[28] A.I. Al-Saleem, A.M. Al-Jobair Possible association between acetazolamide administration during pregnancy and multiple congenital malformations Drug Des Devel Ther., 10 (2016), pp. 1471-1476

[29] L.B. Holmes, H. Kawanishi, A. Munoz Acetazolamide: maternal toxicity, pattern of malformations, and litter effect Teratology., 37 (1988), pp. 335-342

[30] R. Palop, E. Choed-Amphai, R. Miller Epidural anesthesia for delivery complicater by benign intracranial hypertension New York City: Anesthesiology., 50 (1979), pp. 159-160

[31] E. Abouleish, V. Ali, R. Tang Benign Intracranial hypertension and anesthesia for cesarean section Anesthesiology., 63 (1985), pp. 705-707

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