Management of idiopathic intracranial hypertension in parturients: anesthetic considerations

  • Iosifina Karmaniolou
  • Georgios Petropoulos
  • Kassiani Theodoraki
Review Article/Brief Review

Abstract

Purpose

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.

Source

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”.

Principal findings

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.

Conclusion

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.

Keywords

Cesarean Delivery Intracranial Hypertension Idiopathic Intracranial Hypertension Ventriculoperitoneal Shunt Carbonic Anhydrase Inhibitor 

Prise en charge de l’hypertension intracrânienne idiopathique chez la parturiente: considérations anesthésiques

Résumé

Objectif

L’hypertension intracrânienne idiopathique (HII) est une condition rare qui se caractérise par une pression intracrânienne (PIC) élevée sans pathologie connexe au niveau du cerveau ou de la composition du liquide céphalorachidien (LCR). Nous proposons ici une brève synthèse de la présentation clinique de l’HII et quelques considérations anesthésiques chez les parturientes avec un diagnostic de ce trouble.

Source

Nous avons réalisé une recherche de la littérature sur MEDLINE® pour extraire tous les articles publiés en anglais en posant comme contrainte l’année de publication, et avons utilisé les termes de recherche « idiopathic intracranial hypertension » (hypertension intracrânienne idiopathique), « pseudotumor cerebri » (méningite séreuse), « benign intracranial hypertension » (hypertension intracrânienne bénigne), « pregnancy » (grossesse), « cesarean section » (césarienne), « labour analgesia » (analgésie pour le travail obstétrical), « epidural » (péridurale), et « anesthesia » (anesthésie).

Constatations principales

L’hypertension intracrânienne idiopathique affecte principalement les femmes obèses en âge de procréer. Les céphalées sont le symptôme principal, et le symptôme cardinal est l’œdème papillaire. L’objectif principal de la prise en charge est de conserver la fonction visuelle. Le traitement consiste à administrer des diurétiques et des corticostéroïdes, à contrôler une prise de poids excessive, et à effectuer une prise en charge chirurgicale, telle que le détournement du liquide céphalorachidien ou la fenestration de la gaine du nerf optique dans les cas réfractaires. L’accouchement par césarienne n’est pas forcément indiqué chez la parturiente atteinte d’HII. L’anesthésie neuraxiale a été utilisée sans complication pour l’analgésie du travail obstétrical et pour les accouchements par césarienne. Certains cas rapportés décrivent l’utilisation réussie d’anesthésie rachidienne et de péridurale, même chez les patientes atteintes d’HII et chez lesquelles étaient positionnés des appareils de dérivation du LCR.

Conclusion

Bien que l’HII soit rare, certaines considérations particulières s’appliquent à la prise en charge anesthésique de la parturiente atteinte de ce trouble. Malgré la présence d’une PIC élevée chez ces patientes, il n’existe pas de contre-indication spécifique aux techniques neuraxiales, et on n’a pas rapporté d’hernie uncinée chez les patientes atteintes d’HII.

Notes

Competing interests

None declared.

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Copyright information

© Canadian Anesthesiologists' Society 2011

Authors and Affiliations

  • Iosifina Karmaniolou
    • 1
    • 2
  • Georgios Petropoulos
    • 1
  • Kassiani Theodoraki
    • 1
  1. 1.Department of AnesthesiaAretaieio Hospital, Medical School, University of AthensAthensGreece
  2. 2.AthensGreece

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