論文の公開元へ腰背部痛で発症し急速に神経障害が進行した脊髄髄膜腫合併妊娠の１例
概要
Meningioma, a benign tumor arising from the meninges, is reported to grow during pregnancy. Therefore, the first symptom may appear during pregnancy. We report a case of pregnancy complicated with spinal menin- gioma, who showed back pain as the first symptom followed by progressing neuropathy, which required surgical management.
A 34-year-old woman experienced low back pain at 32 weeks of gestation. She then noticed numbness and muscle weakness in the lower limbs at 34 weeks of gestation. She visited our hospital at 37 weeks of gestation because of worsening motor disorder of the lower limbs and urinary and fecal incontinence. MRI revealed an intradural, extramedullary spinal tumor 20mm in diameter at the level of C7. Surgical decompression seemed necessary because the symptoms deteriorated even after hospitalization. Cesarean section under general anes- thesia was performed at 37 weeks of gestation, and a 2478g male infant was delivered uneventfully. However, the symptoms worsened even after the Cesarean section ; therefore, the spinal tumor was removed in the prone position on the same day as the Cesarean section. After surgery, the neuropathy gradually improved. The pathological diagnosis of the removed tumor was meningioma and immunohistochemical staining showed the expression of progesterone receptor.
Although lower back pain is a common symptom during pregnancy, meticulous examination including MRI should be considered when the pain is associated with neuropathy. Additionally, physicians should be aware of the possibility of rapid onset and progression of neuropathy during pregnancy in cases of spinal meningioma. Shinshu Med J 68 : 197―202, 2020
