A California woman experienced a rapid reversal of fortune when she was diagnosed with a large tumor pressed against her brain during her last month of pregnancy, only to learn it vanished four months later.
As detailed in a case report in World Neurosurgery, a 23-year-old woman came into the Loma Linda University Medical Center neurology department complaining of severe headaches on the left side of her head, fatigue, periodic blurry vision, nausea, and vomiting that had begun one month prior.
She was in her 37th week of pregnancy and had gone through two previous pregnancies with no complications. An MRI revealed a large growth on the left side of her brain, behind the ear.
The treating physicians suspected it could be an aggressive type of cancer, a cluster of malformed blood vessels prone to hemorrhage, or a type of benign tumor arising from cells in the brain’s surrounding membrane called a meningioma.
Although it is unclear whether the decision came from the medical team or the patient, the team did not operate right away.
About one month after delivering her baby, the woman returned to the hospital, noting that her headaches remained but her vision had returned to normal. Hoping to remove the mysterious mass before it could cause more serious damage, the team planned to operate in the near future.
A little over a month later, a final pre-surgical MRI indicated that the growth had shrunk dramatically, without any medical intervention – a disappearing act that meant the diagnosis of meningioma was spot on and earned the tumor its tongue-in-cheek nickname, "Houdini".
Though it sounds unusual, medical researchers have long noted the odd behavior of meningiomas in pregnant women. These tumors develop most commonly in adults over 60, and the current research suggests that they rarely arise during pregnancy. Yet something about the changes that occur during gestation cause the otherwise slow-growing masses to expand rapidly.
As meningiomas grow, the nearby brain structures are increasingly compressed, eventually resulting in the emergence of the characteristic general symptoms experienced by the case report patient as well as seizures and problems specific to the affected brain area. For example, meningiomas often form in the meninges near the olfactory nerve, impeding one’s sense of smell.
The exact mechanism driving the accelerated growth remains unknown, but researchers have identified fluctuating levels of hormones, certain growth factors, and the increased productivity of the cardiovascular system during pregnancy as the likely suspects.
And because all these changes reverse after pregnancy, meningiomas have been known to quickly shrink or once the patient has given birth. On the other hand, if left unchecked during pregnancy, they often progress to life-threatening sizes.
“In light of the sudden disappearance of the meningioma, no further surgical intervention was pursued,” the authors wrote.
Lead author and neurosurgeon Dr Vikram Chakravarthy told Live Science that doctors will continue to monitor the patient to ensure that the tumor continues to shrink and behaves in a benign manner.