Disclosures: Sara Dykowski, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 32-year-old female with progesterone-mediated meningioma resulting in myelomalacia during pregnancy, initially diagnosed as carpal tunnel syndrome.

Case Description or Program Description: A 32-year-old G2P2002 female was referred for management of carpal tunnel syndrome 3 weeks postpartum. Symptoms started in her third trimester with worsening right-hand pain, paresthesias, and weakness at 36 weeks gestation. She was treated conservatively with a splint. At her initial PM&R evaluation, she reported additional right leg weakness and pain. Exam was notable for right upper and lower limb weakness, positive right Hoffmann and Babinski, and 3 beats of clonus on the right.

Setting: Outpatient PM&R clinic in a tertiary referral center.

Assessment/Results: MRI brain and total spine were ordered in the setting of her exam findings. Imaging revealed an intradural extramedullary mass with dural tail, consistent with meningioma, resulting in mass effect along the right anterolateral spinal cord and enhancement at C2-3. She was emergently admitted for neurosurgical evaluation and underwent C1-3 laminectomy with microscopic mass resection. Post-operatively, she had immediate improvement in strength and sensory symptoms. Patient was discharged home with outpatient physical therapy to continue neurorehabilitation. At her 4-month post-operative visit, symptoms resolved.

Discussion (relevance): This patient’s meningioma most likely reacted to progesterone levels during pregnancy, causing sudden tumor growth. Progesterone has been identified as a cell proliferation promoter in multiple cancers. This case highlights an important clinical consideration for the impact of pregnancy physiology on disease process, in addition to implications hormonal changes can have for patients.

Conclusions: Hormone-mediated tumor growth is important to keep in the differential diagnosis, especially in individuals undergoing rapid hormonal fluctuations such as pregnancy, when performing a neuromuscular evaluation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/progesterone-mediated-meningioma-in-pregnancy-a-case-report/