Central nervous system tumour in pregnancy: a case report

• Main Authors: Abd Malik, Nur Rashidah, Mohd Rashid, Nurul Nafizah, Ismail, Hamizah, Awang, Mohamed Saufi
• Format: Article
• Language: English
• Published: Malaysian Medical Association 2023
• Subjects: RG500 Obstetrics
• Online Access: http://irep.iium.edu.my/105729/1/105729_Central%20nervous%20system%20tumour.pdf; http://irep.iium.edu.my/105729/; https://www.e-mjm.org/2023/v78s1/index.html

Introduction: Central nervous system (CNS) tumour in pregnancy is rare. We report two cases with different challenges. Case Description: Case 1: A 40-year-old at 8 weeks gestation with one-year hands and feet numbness was suspected to have cervical myelopathy. At 20 weeks, she had right sided weakness, bilateral upper limbs hypertonia and hyperreflexia raising suspicion of demyelinating disease. Magnetic resonance imaging (MRI) was withheld due to incompatible right knee implant. There was no progressive impairment until 35 weeks gestation when she had left sided weakness. She had Caesarean section under general anaesthesia. MRI later revealed spine compressing mass from cervico-medullary junction to C3. Seven days postpartum, she had tumour debulking surgery with subsequent neurological improvement. Histopathologic examination (HPE) showed meningioma. Case 2: A 36-year-old lady with four-months headache presented at 23 weeks gestation with vomiting, blurred vision, left sided imbalance and positive cerebellar signs. MRI revealed left cerebellar tumor with hydrocephalus. For pregnancy prolongation, hydrocephalus was relieved with daily cerebrospinal fluid aspiration through Ommaya catheter. At 26 weeks, her symptoms worsened despite additional intravenous steroids. She had Caesarean section and delivered a healthy 1.17kg baby. Subsequently, tumour excision was done and one month later she was asymptomatic with no residual tumor or hydrocephalus on MRI. HPE showed hemangioma. Discussion: Early recognition of CNS tumour is important. Delayed diagnosis compounded with pregnancy-related rapid tumour growth increases morbidity. Subsequent treatment challenge is timely intervention for optimal maternal and foetal outcome. Despite its rarity, suspicion followed by judicial investigation and treatment is imperative.