Postpartum Paraplegia a Tragic Event Caused by an Undiagnosed Spinal Schwannoma Following Cesarean Section: A Case Report with Literature Review

Abstract

Background and Aim: Undiagnosed spinal cord tumors may be underlying cause responsible for a fatal event of paraplegia post cesarean section following spinal anesthesia. Intradural extramedullary spinal cord tumors undergo expansion and acute cord compression due to hemorrhage, hypervolemia, pressure and hormonal changes of pregnancy. Commonly Schwannoma and Ependymoma have been accidentally diagnosed in postpartum women suffering with neurological complaints with no previous medical or surgical co-morbidity. Aim of the presentation is to promote awareness among clinicians to expedite MRI and surgery in case of sudden paraplegia indicating acute compression by a space occupying spinal cord lesion unveiling in pregnancy. Presentation of the Case: Presenting a case who suffered tragic paraplegia post cesarean section, underwent laminectomy with excision of the spinal tumor mass. Histopathology reported this lesion as ‘Schwannoma’. She was managed postoperatively with intense physiotherapy but continues to be paraplegic. A review of literature on spinal cord tumors and hematoma with management plan is described. Discussion: Expansion or hemorrhage triggered by pregnancy changes or leak of cerebrospinal fluid impairs venous drainage to cause sudden acute spinal cord compression resulting in onset of paraplegia. Pregnancy compression of Inferior vena cava increases the venous engorgement in the spinal canal thereby further increasing the cord compression. Gold standard diagnostic modality is MRI. Urgent resort to surgical intervention of removing the mass has favorable prognostic outcome. Conclusion: To avoid a permanent sequela of cord compression by the expanding spinal cord tumor adequate knowledge of this subject needs to be updated and disseminated among neurosurgeons, obstetricians and anesthesiologists for patient safety environment.