Bedside Multimodal Ultrasonography for the Detection of Intracranial Hypertension in Severe Adolescent Preeclampsia: A Case Report and Screening Proposal

Preeclampsia is a leading cause of maternal morbidity and mortality worldwide and is frequently complicated by cerebral edema and elevated intracranial pressure (ICP). Noninvasive neuromonitoring tools such as transcranial Doppler (TCD) and ocular ultrasonography may help detect intracranial hypertension before overt neurological deterioration. We report a 17-year-old primigravida at 34 weeks of gestation who presented with severe preeclampsia and a hypertensive crisis, but without focal neurological deficits. Laboratory tests confirmed severe preeclampsia, and an emergency caesarean section was performed with a good neonatal outcome. Postoperatively, bedside TCD of the middle cerebral artery showed an elevated pulsatility index (PI = 1.25) and resistance index (RI = 0.68). At the same time, ocular ultrasound demonstrated an enlarged optic nerve sheath diameter and optic disc protrusion, both consistent with increased ICP despite the patient's normal neurological exam. This case illustrates the potential role of combined TCD and ocular ultrasonography for early, noninvasive assessment of intracranial hypertension in severe preeclampsia, particularly in adolescent patients. We propose a two-step bedside ultrasound protocol to identify subclinically elevated intracranial pressure.