Long time sabbatical - but thought I'd revisit with an interesting case I did recently:

34 yo G1P0 at 27 weeks presenting with severe headaches at my pain clinic. Pt had been diagnosed with Idiopathic Intracranial Hypertension approximately 1 year ago and treatment with acetazolamide. Once the patient found out she was pregnant, her neurologist recommended to stop the acetazolamide and monitor her. Subsequent physical exams showed increasing bilateral papilledema as well a severe headaches. Pt is noted to be 62" and 305 lbs. First attempted LP in neurology center showed opening pressures of 28 cm/h20 and 20 ml of CSF was passively drawn off. Symptoms resolved for 2 months and a repeat LP was then done at the same office. Unfortunately, d/t to patients increasing weight, neurologist was unsuccessful after many attempts and called in an in house MDA. Access in a side laying position was not possible even with US and after 90 minutes was able to obtain correct needle placement with patient sitting upright for drawing off CSF.

She now presents as a add on case where her OB has sent her to you d/t the patients previous experience. Opening pressure need to be obtained and an average volume of CSF to be taken off.

AM VS are stable and she is afebrile.

Thoughts, concerns, plan?