title: Hemorrhage of cavernous malformations during pregnancy and in the peripartum period: causal or coincidence? Case report and review of the literature.
abstract: 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.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA. neuropub@chw.edu
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.forename: Iman
authors.initials: I
authors.lastname: Feiz-Erfan
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.forename: Louis
authors.initials: L
authors.lastname: Kim
authors.forename: Seref
authors.initials: S
authors.lastname: Dogan
authors.forename: Randall W
authors.initials: RW
authors.lastname: Porter
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag
mesh_terms: 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