Disclosures: Francis Walson, BS: No financial relationships or conflicts of interest

Case Diagnosis: C4-AIS-C paraplegia post-resection of C7 to T4 intradural intramedullary ependymoma

Case Description or Program Description: The patient is a 31-year-old woman with a past medical history of rheumatoid arthritis, high-risk pregnancy, and pre-eclampsia in prior pregnancy who presented with chronic lower back pain for two months along with weakness, hyperesthesia, and gait dysfunction over the past 4 months. The patient was in the second trimester of pregnancy when a holocord, intramedullary, expansile spinal tumor extending from C7-T4 was discovered. Two weeks later, gross resection of the tumor was performed and pathology was reported consistent with ependymoma.

Setting: Lehigh Valley Hospital (LVH)–Cedar Crest

Assessment/Results: Post-operatively, the patient has an incomplete spinal cord injury (C4-AIS-C) with complete bilateral lower extremity paraplegia, and some loss of sensation, bowel control, and bladder control. A week later, she suffered a bilateral pulmonary embolism and emergency C-section was done. She has bilateral lower extremity paralysis, left C6 motor, left C8 sensory, right C8 motor, right T1/T2 sensory level ASIA B symptoms with some deep anal sensation.

Discussion (relevance): The patient’s onset of C4-AIS-C symptoms and progression to ASIA B symptoms with flaccid paraplegia in lower extremities, weakness in upper extremities, and mild loss of sensation and bowel/bladder control suggest a spinal cord lesion stemming from the ependymoma. Literature indicates gross tumor resection as best treatment, given she was 28 weeks pregnant and suffered rapid progression of pain/weakness. However, lack of case reports regarding pregnant women undergoing an ependymoma resection, combined with limited reviews relevant to spinal cord tumor resection and outcomes in this population, make this case noteworthy.

Conclusions: Spinal tumors are rare in pregnant patients, and ependymomas are characterized as low-grade malignancies, so the circumstances surrounding the resection and subsequent rapid neurological decline are very rare. Therefore, this case provides more insight into ependymomas in pregnant women and implications for post-operative rehabilitation in this population.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/incomplete-spinal-cord-injury-following-an-intramedullary-cervicothoracic-spinal-ependymoma-resection/