Symptomatic vertebral hemangioma related to pregnancy

Abstract

In this paper, we report a case of vertebral hemangioma during pregnancy in a 21-year-old woman presenting with paraparesis of rapid onset. An emergency MRI scan of the dorsal spine showed a lesion of the ninth thoracic vertebra with extradural extension and marked spinal cord compression. A cesarean section was done, and this was followed by emergent laminectomy. Her symptoms and neurologic deficits quickly improved. The etiopathogenesis, clinical, radiological features, and treatment modalities are discussed in the light of the literature.

Undiagnosed vertebral hemangioma causing a lumbar compression fracture and epidural hematoma in a parturient undergoing vaginal delivery under epidural analgesia: a case report

“…In females, radicular pain and neurological deficits associated with vertebral hemangiomas may develop during pregnancy. 4,5 Compression of the inferior vena cava by the gravid uterus and elevation of intra-abdominal pressure enhance the blood flow through the vertebral venous plexus. This mechanism, along with a 30-50% increase in circulating blood volume, may gradually lead to expansion of an existing vertebral hemangioma.…”

“…The third trimester, in particular, represents a high-risk period where previously asymptomatic vertebral hemangiomas may cause a variety of neurological symptoms such as radicular pain, sensory and motor deficits, even incontinence. 3,4 The implicated mechanisms include pregnancy-related hemodynamic, mechanical, and hormonal changes which result in vascular distension and growth of these vessel-rich tumours. 1 Herein, we describe an unusual case of vertebral fracture due to a hemangioma presenting as postpartum back pain following epidural analgesia.…”

Symptomatic vertebral hemangiomas during pregnancy

“…13 Since that first publication, 27 new cases have been described (Table 1). 1,[3][4][5][6][7][8][9][10][11][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29] The diagnosis was usually made during the third trimester (22 of 27 cases). The mean maternal age at the time of diagnosis was 30 years.…”

“…[6][7][8][9]11,[19][20][21]24,26,28,29 Only half of these cases were treated antepartum. 8,[19][20][21]28 Only 1 of the 8 cases of prematurity (between 32 and 36 weeks of gestation) 1,3,10,[13][14][15]19,23 was treated antepartum.…”

“…The postpartum surgical management performed by most authors is laminectomy (12 of 19 cases), 1,[3][4][5]7,9,10,14,22,26,27,29 without a complementary procedure in half of the cases. Neurological recovery was observed in all but 1 case in this group; 26 recovery was only partial after laminectomy and the patient was subsequently treated by embolization and corpectomy.…”