Spinal intradural hemorrhage due to a neurinoma in an early puerperal woman.
A spinal intradural hemorrhage due to a neurinoma is very rare and requires emergency surgery. We report the first case of a spinal intradural hemorrhage due to a neurinoma in an early puerperal woman. The patient had a history of intermittent episodes of lower back pain for 3 years. The antenatal course to that time had been uneventful. Two days after a normal vaginal delivery, she presented with sudden onset of spinal lesion with severe symptoms and an emergency laminectomy was performed to remove an intradural hemorrhagic lesion due to a neurinoma. In this case, we speculate that clots in the intratumoral vessels spontaneously occurred during pregnancy and obstructions of these vessels followed by necrosis and hemorrhage of distal tissues occurred in the early postpartum stage. Moreover, the change in posture caused by the change in the maternal center of gravity following delivery, as well as the frequent bending required for the care of the newborn, may have been contributing factors. Mild but repetitive traction force caused by the change in posture and frequent bending may have created exertion on the vascular attachment to the nerve roots, causing the intradural hemorrhage.
Department of Obstetrics and Gynecology, Mie Prefectural Shima Hospital, 1257 Ugata, Ago, Shima 517-0595, Mie, Japan. hirohiko@ztv.ne.jp
Hirohiko
H
Tanaka
Eiji
E
Kondo
Hiroaki
H
Kawato
Toyo
T
Kikukawa
Akinori
A
Ishihara
Nagayasu
N
Toyoda
D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D009442:Neurilemmoma / Q000150:complications* / Q000601:surgery; D011187:Posture; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology* / Q000601:surgery; D011644:Puerperal Disorders / Q000209:etiology* / Q000473:pathology; D013118:Spinal Cord Diseases / Q000209:etiology*; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000601:surgery