Ruptured Filum Terminale Ependymoma as an Uncommon Cause of Refractory Lumbosciatica in a Pregnant Patient: Case Report

Abstract

Lumbar pain and sciatica are a common complaint during pregnancy. Neoplastic etiologies, although rare, require consideration in the differential diagnosis, particularly in the presence of acute onset, severe symptoms, or neurologic deficits.

We present the case of a 33-year-old woman at 31 weeks gestation presenting with acute, progressive lumbar pain, bilateral sciatica, and motor weakness. Neurological examination revealed bilateral lower extremity motor weakness (M4) in L3, L4, and L5 myotomes, with hyperreflexia and Brudzinski and Kernig signs. Magnetic resonance imaging demonstrated an L2-L3 level expansive intradural lesion compressing the descending nerve roots, consistent with a filum terminale ependymoma. A cesarean section occurred at 33 weeks gestation, followed by a tumor resection three days later. Histopathology confirmed the diagnosis of a myxopapillary ependymoma. The patient experienced a favorable postoperative course, with resolution of sciatica and gradual improvement in motor function. At the four-month follow-up, she regained normal ambulation and could care for her infant independently. She returned to her work duties six months after surgery.

This case highlights the importance of considering spinal tumors in the differential diagnosis of acute lumbosacral radiculopathy with neurologic deficits during pregnancy. Early diagnosis and prompt surgical intervention can lead to a favorable outcome for both mother and baby.

Keywords

lumbar pain - pregnancy - spinal tumors - ependymoma

Publication History

Received: 27 November 2023

Accepted: 12 August 2024

Article published online:
25 September 2024

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