A delicate balance: Managing intracranial hypertension in pregnancy

Abstract

Idiopathic intracranial hypertension (IIH) is a condition marked by increased intracranial pressure with no identifiable cause, most commonly affecting young, obese women. We present the case of a 24-year-old primigravida with a body mass index of 37, ventricular septal defect repair, and type II diabetes mellitus, who presented at 15 weeks of gestation with blurred vision and reduced visual fields in her right eye. On examination, a grade 2 relative afferent pupillary defect was noted in the right eye, alongside bilateral optic disc swelling. Despite normal neuroimaging and cerebrospinal fluid analysis, a high opening pressure of 33.5 cmH2O was documented during lumbar puncture. A multidisciplinary team from neurology, ophthalmology, and obstetrics, initiated treatment with acetazolamide and topiramate, along with a lumbar drain and serial lumbar punctures. The patient successfully delivered a healthy baby girl via emergency caesarean section at 37 weeks of gestation. After delivery, her optic nerve functions remained stable, although some chronic damage was evident. This case underscores the importance of multidisciplinary collaboration and careful treatment planning for IIH during pregnancy to safeguard both maternal and foetal health.