• HPI: The patient a 19-year-old female who presented several weeks of progressive headaches with associated vomiting. She is 30 weeks pregnant and has had an uncomplicated pregnancy thus far. She denies visual changes, numbness/tingling/weakness in the extremities. 

    PMH: Unremarkable 

    Social History: Works at a retail store. Does not smoke or drink. 

    Family History: Sister with a “benign” brain tumor that was biopsied and is currently that is being followed nonoperatively. 

    Exam: Fundoscopic exam demonstrates bilateral papelledema, otherwise nonfocal. 

    Figure 1. Axial post contrast (left) and noncontrast T1-weighted MRI demonstrating a large, nonenhancing left frontal mass with associated mass effect.

     

    Figure 2. Axial T2-weighted (left) and coronal FLAIR MRI demonstrating the large mass with obstructive hydrocephalus and associated transependymal flow.

    1. Given that the obstetrics service has cleared the patient to have general anesthesia, what would you do to manage this patient?

    2. Would you place this patient on perioperative steroids?

    3. Given the patientÂ’s history and the imaging appearance of this lesion, what do you think is the most likely pathology?

    4. Which of the following describes you?

    5. I practice in one of the following locations.

    6. Please add any suggestions or comments regarding this case:

    • I would like to go for an early child birth and put the child under care of neonatologists.
    • The DD should include besides the central neuricytoma,subependymoma,ependymoma
    • I think there may be another strategy in the management especially patient is pregnant in more than 7th month so elective CS and ICP monitoring with access to CSF for drainage if needed in addition to some dehydrating medications till doing craniotomy few days after delivery.
    • She could be operated waiting until 32 or 34 weeks to take out the product not until 36 giving steroids for lung maduration, and placing the intraventricular drains if there is neurological deterioration only relieving a little the intracranial hypertension but the main reason for the symptomatology is the compression by the tumor not the hydrocephalia
    • DR ADRIAN SANTANA RAMIREZ GUADALAJARA JALISCO MEXICO adrisanta@yahoo.com
    • thanks all This case of left lateral ventricular tumor located mainly in the frontal horn needs just few weeks to safe the foetus firstly which can be done by CSF diversion followed by surgical approaching the lesion at the ideal time in cooperation with obstetrics.
    • She is in need to search for SEGA because of IVLesion ang family history . Although she in third trimaster of pregnancy -if following surgery abortion take place , baby can be managed in neonatal care .transfrontal transventricular approach is recommended .
    • MRI with contrast images not available
    • Should go for elective section if fetal maturity enough/clearance from the obstetric side & go for a definitive surgery with excision of sol .
    • about my current job situation this is my first year after graduation in from the university now i have completed just 6 months of practise
    • thanks for de opotunity to participeted
    • thanks for de opotunity to participeted
    • it is an interristing case i d like to have a feed back thanks
    • could place evd until lung maturity (32 33weeks?) then do c section followed by craniotomy to minimize time of evd and risk of infection.

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