Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature.
There is growing evidence to suggest that pregnancy may increase the risk of hemorrhage from cavernous malformations (CMs). In the present case, a 21-year-old primigravida was admitted to the authors' neurosurgical service after a cesarean section. Three weeks before admission she had experienced rapidly progressive bilateral lower-extremity paresthesias. Spinal magnetic resonance (MR) imaging revealed the presence of an intramedullary thoracic lesion. On T2-weighted MR images, heterogeneous signal intensity with a rim of decreased intensity was demonstrated in the spine. The mass was successfully resected, and 1 year later the patient's symptoms had resolved completely. This is the fourth reported case of a spinal intramedullary CM that became symptomatic during pregnancy. The pathogenesis and management of this entity are reviewed.
Safavi-Abbasi
Sam
S
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA. neuropub@chw.edu
Feiz-Erfan
Iman
I
Spetzler
Robert F
RF
Kim
Louis
L
Dogan
Seref
S
Porter
Randall W
RW
Sonntag
Volker K H
VK
D000328:Adult; D002585:Cesarean Section; D018450:Disease Progression; D042241:Early Diagnosis; D004638:Emergency Treatment / Q000592:standards; D005260:Female; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods; D010292:Paresthesia / Q000209:etiology / Q000503:physiopathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013116:Spinal Cord / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D013120:Spinal Cord Neoplasms / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014680:Veins / Q000002:abnormalities* / Q000473:pathology / Q000503:physiopathology