Intracranial tumors in pregnancy

Brain tumors are the fifth leading cause of cancer-related death in women ages 20 to 39 years. Although the presentation of intracranial tumors during pregnancy is relatively uncommon, neurosurgeons and obstetricians will undoubtedly encounter these patients in their everyday practices [1]. Symptoms and physical findings are not different from those of the nonpregnant population, although pregnancy may occasionally delay diagnosis. There is some evidence to suggest that the different types of brain tumors seen in pregnant women occur with the same relative frequency as those seen in age-matched nonpregnant counterparts [2]. Gliomas represent the majority of symptomatic intracranial neoplasms, followed closely by meningiomas and then acoustic neuromas. Clinical features All primary as well as metastatic brain tumors share common clinical features that range from headache, nausea & vomiting, and other nonspecific symptoms to focal neurologic deficits such as hemiparesis and visual field defects. Pregnancy can exacerbate neurology, with the patient presenting acutely with impending or actual cerebral herniation: worsening headache, deteriorating Glasgow Coma Scale score, dilating ipsilateral pupil, hypertension, bradycardia, and respiratory irregularity [3]. Common symptoms of increased intracranial pressure, including nausea & vomiting, can potentially be confused with routine pregnancy-related conditions such as hyperemesis gravidarum, thereby posing specific diagnostic challenges for physicians. Physicians should in general have a low threshold to obtain a neuroimaging study in a patient in whom there is any concern for an intracranial mass lesion, and the onset of any new focal neurologic deficit during pregnancy warrants immediate evaluation with an imaging study.