Pseudotumor cerebri in pregnancy: Course, management, outcome

Purpose. To evaluate the course, management of pseudotumor cerebri (PTC) during pregnancy. Methods. Review of medical charts of all women diagnosed with PTC who were also pregnant to determine symptoms, neuro-ophthalmological findings, neuroimaging studies, treatments, visual and pregnancy outcome. Results. Among 300 PTC patients, 7 were diagnosed or had active ITC during pregnancy with gestation age from 2-6 months at presentation. Symptoms typical of PTC were occurred: headaches (5), visual obscurations (4), and diplopia (2). Acuity was decreased severely in 1 and mildly in 3 patients. Six had marked bilateral papilledema. Visual field loss occurred in 2 patients; 5 had only enlarged blind spots. Symptoms and abnormal clinical findings resolved after diagnostic LP and salt-restricted diet in 2, while 2 needed 3 days of CSF drainage. One patient received acetazclamide and a medical abortion. One patient had an optic nerve fenestration, a lumboperitonial shunt and corticosteroids. Visual acuity improved in all cases. Severe visual field loss persisted in 1 case. There were 5 full term normal deliveries, 1 intrauterine fetal death, and 1 therapeutic termination. Conclusions. PTC can occur in any trimester with typical symptoms and findings. Visual outcome of pregnant women is the same as for patients who are not pregnant. Treatment should be oriented towards weight control and repeat CSF drainage if needed.