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Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Number 10

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Ginecol Obstet Mex 2023; 91 (10)

Posterior fossa ependymoma in a pregnant woman: differential diagnosis of hyperemesis. Case report

Fernández GI, Rames CM, Manero-Hernando I, Romero SM, Gallego SY, Sancho SA

Language: Spanish
References: 14
Page: 768-773
PDF size: 215.86 Kb.


ABSTRACT

Background: Intracranial tumours are diagnosed very rarely during pregnancy. The initial symptoms include headache, nausea and frequent vomiting, which are characteristic of pregnancy, so a correct differential diagnosis is necessary.
Clinic case: Primigravida patient, 25 years old, 11+4 weeks pregnant, with a history of vomiting, headache, dizziness and instability of subacute onset in the last two months. History of interest: tension-type headache compared with chronic migraine, not previously studied. On examination, slowed speech, bilateral gaze-evoked nystagmus and left periocular pain were noted, together with incoercive vomiting that did not resolve despite a strict diet and prescribed metoclopramide and pantoprazole. A contrast-enhanced MRI of the brain showed a tumour mass centred in the fourth cefaventricle. Based on the above, a suboccipital craniectomy was performed with subtotal excision of the tumour and anatomopathological diagnosis of group A posterior fossa ependymoma. The interruption of pregnancy was proposed and accepted by the patient to complete the adjuvant treatment with radiotherapy. The surgical intervention left her with significant neurological sequelae that merited rehabilitation.
Conclusions: The time of diagnosis is crucial in the management of intracranial tumours, especially if they are malignant, as a balance must be struck between the health of the mother and the viability of the pregnancy. As these are patients with a complex condition, their medical care must be multidisciplinary in order to reduce the risks to the mother and foetus.


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