Headache is a common complaint during pregnancy and the puerperium. The differentiation between a benign headache and a headache that has an underlying more endangering cause, such as an intracranial tumor, can be difficult and often requires diagnostic procedures and brain imaging techniques. We report the case of an 18-year-old female patient who developed clinical symptoms—persistent headache followed by neurological deficit—in the last part of her pregnancy. A medulloblastoma (MB) was diagnosed and treated after delivery. We review 11 other cases of MB in pregnancy reported in the literature. The most common clinical manifestation at diagnosis was headache followed by neurological deficits. We discuss the association of brain tumor growth with physiological changes during pregnancy. We conclude that clinical features of intracranial tumors can be misinterpreted as pregnancy-related symptoms and should not be dismissed.
Cerebral arteriovenous malformations (AVM) are fistulous connections between arterial and venous blood flow, consisting of an abnormal tangle of dysplastic arteries and veins, without capillary vessels or interposed functional brain parenchyma. Management of pregnant patients with unruptured AVMs remain a dilemma for both obstetricians and neurosurgeons, due to the scarcity of data about this condition. Decisions are made weighting the risk of bleeding during pregnancy and the neurological status of the patient against the risks associated with a neurosurgical intervention. Most studies suggest that the bleeding risk does increase slightly during pregnancy, but further large prospective studies are needed. This article selects and reviews literature data to convey recommended management strategies for unruptured cerebral vascular malformations during pregnancy, childbirth and puerperium.
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