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Neoplastic Intracranial Lesion in a Parturient
Abstract Number: SU-83
Abstract Type: Case Report/Case Series
Intracranial tumors during pregnancy are rare, with an estimated incidence of malignant brain tumors in 3.6/1 million live births. We present a case of a neoplastic intracranial lesion in a parturient.
A 22-year-old G4P3 female at 26 5/7-weeks EGA presented with persistent nausea/vomiting unresponsive to oral therapies. She was admitted to the obstetric service for hyperemesis gravidarum. Upon further questioning, the patient reported a 40-pound unintentional weight loss and persistent headache, with double vision. The MRI revealed a mass-like lesion in the left ambient cistern 1.8 x 1.9 cm in size with mass effect on the midbrain and associated obstructive hydrocephalus. There was also multifocal leptomeningeal enhancement involving cerebellum and cerebral hemispheres, and a plaque-like configuration of the medullary brainstem and cervical cord.
The patient was transferred to Neurocritical Care (NCC) with Neurosurgery, Hematology-Oncology, Maternal Fetal Medicine and Obstetric Anesthesia consults. She underwent a suboccipital craniectomy with laminectomy for biopsy. We placed an arterial line prior to a rapid sequence induction and maintained the patient with propofol, remifentanil and a phenylephrine infusion to maintain adequate perfusion. The operation proceeded in the prone position and was tolerated well with 150 ml of blood loss and extubation in the operating room. Fetal heart tones were confirmed prior to and following the procedure.
She had a decline in neurologic status over the next two weeks, requiring an emergent cesarean delivery under general anesthesia secondary to non-reassuring fetal heart tones. A 29 3/7-week male infant was delivered. The patient returned to NCC where she rapidly declined. She did not have a histopathologic diagnosis, with the final report describing an unusual spindle cell and epithelioid cell neoplasm of indeterminate type. Following an 82-day hospital course, it was determined the patient would not withstand chemotherapy or radiation and the family decided upon hospice care.
Intracranial tumors presenting in pregnancy are rare, requiring much forethought and coordination for imaging, diagnostics, and treatment. As demonstrated in this case, care must be taken not to confuse nausea and vomiting due to an intracranial lesion with hyperemesis gravidarum.