To describe a case of idiopathic intracranial hypertension (IIH) in a pregnant female in her first trimester who improved following venous sinus stenting (VSS).

Management of IIH in pregnancy is challenging, and untreated IIH may result in complete vision loss. Mild disease is medically managed with ICP-lowering agents and weight loss; surgical options for more severe disease include optic nerve sheath fenestration, CSF shunting, and the emerging technique of VSS. Surgery is typically reserved for fulminant disease or failed medical management. Proposed criteria for VSS includes evidence of venous sinus stenosis on imaging and a high trans-stenotic pressure gradient (> 10 mm Hg).

A 13-weeks pregnant G2P1001 26-year-old African American female with past medical history of uncontrolled hypertension and morbid obesity presented for evaluation of hypertensive urgency, headache, and blurry vision. Examination revealed a right relative afferent pupillary defect and right abducens palsy along with severe papilledema on dilated funduscopic examination. Lumbar Puncture showed an elevated opening pressure. Diagnostic Cerebral Angiogram revealed left transverse-sigmoid sinus junction stenosis with high trans-stenotic pressure gradient of 50 mmHg. Given advanced symptoms with high pressure gradient, and possible risk initiating acetazolamide (Category C Drug) or topiramate (Category D Drug), the patient was managed surgically with venous sinus stenting with subsequent improvement in her symptoms. 

This is a unique case of IIH in a pregnant patient with venous sinus stenosis and markedly elevated sinus pressure gradient, which improved with VSS.