Benign intracranial hypertension (BIH) in pregnancy

Abstract

INTRODUCTION: Benign intracranial hypertension (BIH) is a rare disorder of unknown aetiology that is most often seen in obese women of reproductive age. BIH is a syndrome of increased intracranial pressure without hydrocephalus or a mass lesion with elevated cerebrospinal fluid {CSF} pressure. Both pregnancy and exogenous estrogens are thought to promote BIH or worsen it. CASE REPORT 1: A 32-year old mother in her third pregnancy with two living children presented at 38 weeks of gestation. She was diagnosed to be having BIH after her second pregnancy. She had used oral contraceptive pills for five years. She was on Acetazolamide 0.5 mg twice a day. She delivered a 2960g baby by elective caesarean section under general anaesthesia. CASE REPORT 2: A 37-year old mother in her third pregnancy with two living children presented at 40 weeks of gestation. Her first two babies were delivered vaginally and thereafter she was on oral contraceptive pills for seven years. She was diagnosed to be having BIH for the last two years and was on lumboperitoneal shunt after laminectomy. She went into spontaneous labour and it was augment with oxytocin. The baby was delivered vaginally and the second stage of the labour was shortened by applying low cavity forceps. DISCUSSION: The method of treatment should aim to preserve vision and to improve symptoms. The medical therapy includes weight control, diuretics, steroids, analgesics and surgical methods were optic nerve sheath fenestration and lumboperitoneai shunt. Case reports indicate that pregnant women can go into normal vaginal delivery, and decisions regarding the mode of delivery and anesthesia should be based within a multidisciplinary approach. The use of outlet forceps has been suggested to prevent prolonged second-stage labour. Spinal anesthesia has been shown to be safe and effective in a patient without prior LP shunt. In pregnant women with a preexisting LP shunt, general anesthesia for cesarean section has been recommended due to potential damage to the shunt during spinal needle insertion.