March 23rd, 2018

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Subependymal Giant Cell Astrocytoma Associated with Tuberous Sclerosis Complex in Pregnancy: A Case Report
Authors:  Chinedu Nwabuobi, M.D., M.S., James Towner, M.D., Mary Towner, M.D., and Neil Seligman, M.D., M.S.
BACKGROUND: The management of tuberous sclerosis complex in pregnancy is not well described due a paucity of data. In patients with neoplasms associated with tuberous sclerosis complex, the physiologic changes in hormonal balance and intravascular volume may precipitate neurologic crises. We report a case of a patient with a subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex who presented with acute neurological symptoms in pregnancy.

CASE: A 25-year-old woman, G2P0010, with a known SEGA was previously treated with surgical excision but experienced recurrence, which was stable and being managed medically. Her pregnancy was complicated by fetal tuberous sclerosis complex and maternal onset of symptomatic, acute hydrocephalus at 39+4 weeks’ gestation. Imaging demonstrated increased growth of the previously stable neoplasm with resultant obstructive hydrocephalus. She was admitted to the neurologic intensive care unit and required close, collaborative management among Obstetrics, Neurosurgery, Neurology, and Pediatrics to safely deliver her infant without endangering her life. She delivered via cesarean delivery and then required multiple surgeries to manage her hydrocephalus.

CONCLUSION: Treating gravid patients with tuberous sclerosis complex demands a knowledge of the sequelae and manifestations of the disease process.
Keywords:  Bourneville-Pringle disease, hydrocephalus, pregnancy complications, subependymal giant cell astrocytoma, tuberous sclerosis
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