信州医学雑誌
Online ISSN : 1884-6580
Print ISSN : 0037-3826
ISSN-L : 0037-3826
症例
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
長井 友邦小原 久典菊地 範彦安藤 大史田中 泰裕浅香 亮一布施谷 千穂宮本 強金井 誠伊東 清志塩沢 丹里
著者情報
キーワード: 妊娠, 腰背部痛, 脊髄髄膜腫
ジャーナル フリー

2020 年 68 巻 4 号 p. 197-202

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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 meningioma, 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 anesthesia 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.

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