| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (OA) Class of 2020, Baylor College of Medicine, Houston, Texas |
| Transcript |
Idiopathic intracranial hypertension during pregnancy, IIH. As you know idiopathic means there is no cause, and its intracranial hypertension because you have increased intracranial pressure. So as with regular IIH in non pregnant patients, the symptoms the signs and the radiograph as well as the lumbar puncture all have to show increased intracranial pressure related phenomenon. So the symptoms of increased intracranial pressure; headache, nausea, vomiting, pulsating tinnitus, transient visual obfuscations and diplopia for non localizing sixth nerve palsy. The signs; visual loss, usually enlargement of a blind spot or visual field defects of the neurofiber layer type, papilledema, and sixth nerve palsy are also all from increased intracranial pressure. And the radiograph, MRI, and MR venogram should only show signs of increased intracranial pressure, that's fluid in the sheath, empty sella, stenosis at the junction of the transverse and sigmoid sinus, and of course the lumbar puncture shows elevated opening pressure and the CSF content is normal. So all of that is the same in IIH in pregnancy, the things that are different are number one the treatment. Diamox, acetazolamide, is a category C agent in the FDA classification and what that means is we prefer not to use acetazolamide in pregnancy especially in the first or second trimester, but probably we can use it in the third trimester. Gadolinium, for MRI, is a category C agent as well and so we probably wouldn't want to give gadolinium to a pregnant lady even though MRI by itself is probably safe. And you can do a lumbar puncture in pregnant ladies, and in fact serial lumbar punctures, which are not recommended for normal IIH, can be used in pregnant ladies if they are trying to avoid the use of medicines or surgeries. Weight gain is common in pregnancy and we would like to have an appropriate weight gain in pregnancy, because weight gain can worsen pseudo tumor, so as opposed to regular non pregnant IIH we can't really say weight loss. And so normally we'd follow each patient though each trimester of pregnancy. If we consult with OBGYN it is not considered a high risk pregnancy, we don't really have a preference on delivery via spontaneous vaginal delivery or cesarean section and probably there are pros and cons for either one in terms of pushing versus surgery. And we're trying to avoid surgery, shunting procedure or sheath fenestration, in pregnant ladies, usually the anesthesia is the main problem there. So if we can get patients through their pregnancy with just observation that's the best, serial LP's could be used, Diamox we like to save for the third trimester, and try to avoid surgery is we can. Otherwise everything else is the same in IIH in pregnant patients versus IIH in non pregnant patients. |
