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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2024; 65(02): e102-e107
DOI: 10.1055/s-0044-1790193
Reporte de Caso | Case Report

Ependimoma del filum terminal roto como causa infrecuente de lumbociática refractaria en paciente embarazada: Reporte de caso

Article in several languages: español | English
Esteban Espinoza 
1   Hospital San Camilo, San Felipe, Chile
,
Manuel González
1   Hospital San Camilo, San Felipe, Chile
,
Ratko Yurac
2   Clínica Alemana de Santiago, Vitacura, Chile
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Resumen

El dolor lumbar y la ciática son síntomas frecuentes durante el embarazo. Sin embargo, las etiologías neoplásicas, aunque raras, deben considerarse en el diagnóstico diferencial, particularmente en presencia de inicio agudo, síntomas graves o déficits neurológicos.

Presentamos el caso de una mujer de 33 años con 31 semanas de gestación que se presentó con dolor lumbar agudo y progresivo, ciática bilateral y debilidad motora. El examen neurológico reveló debilidad motora bilateral en las extremidades inferiores (M4) en los miotomas L3, L4 y L5, con hiperreflexia y signos de Brudzinski y Kernig. La resonancia magnética evidenció una lesión intradural expansiva a nivel L2-L3 que comprimía las raíces nerviosas descendentes, compatible con un ependimoma del filum terminal. Se realizó una cesárea a las 33 semanas de gestación, seguida de resección del tumor tres días después. La histopatología confirmó el diagnóstico de un ependimoma mixopapilar. La paciente experimentó un curso postoperatorio favorable, con resolución de la ciática y una mejora gradual de la función motora. A los cuatro meses de seguimiento, había recuperado la deambulación normal y podía cuidar a su bebé de forma independiente. Regresó a sus actividades laborales seis meses después de la cirugía.

Este caso enfatiza la importancia de considerar los tumores espinales en el diagnóstico diferencial de la radiculopatía lumbar aguda con déficits neurológicos durante el embarazo. El diagnóstico precoz y la intervención quirúrgica oportuna pueden conducir a un resultado favorable tanto para la madre como para el bebé.

Palabras clave

dolor lumbar - embarazo - tumores espinales - ependimoma


Publication History

Received: 27 November 2023

Accepted: 12 August 2024

Article published online:
25 September 2024

© 2024. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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