Symptomatic meningioma in the third trimester of pregnancy: a case report from Kenya

Meningiomas, the most common primary central nervous system (CNS) tumors, are typically benign and hormonally responsive. They have a higher incidence in women, particularly during the reproductive years. Pregnancy may trigger rapid tumor progression and symptom onset due to elevated hormone levels. Although rare in pregnancy, meningiomas may adversely affect maternal and fetal outcomes, increasing the risk of complications such as preterm labor and gestational hypertension. Management strategies range from conservative monitoring to surgical intervention depending on gestational age, tumor size, severity of symptoms, and maternal-fetal stability. This report describes the case of a 34-year-old woman (para 1 + 2, gravida 4), with a history of type 1 diabetes mellitus, who presented to an obstetric emergency unit at 32 weeks of gestation. She had a one-day history of projectile vomiting (three episodes), severe global headache, right-sided hemiparesis, speech difficulty, and reduced fetal movement. She also had pre-existing anemia and a Glasgow Coma Scale (GCS) score of 14/15 on admission. Brain MRI revealed a left medial sphenoid meningioma with midline shift and hydrocephalus. On day 2, she underwent emergency caesarean section due to fetal tachycardia and distress. She was later admitted to intensive care after her GCS score dropped to 10/15 and she developed feeding difficulties. 2D echocardiography revealed a left ventricular ejection fraction of 38%. An emergency craniotomy was performed on day 4, and the tumor adherent to the middle cerebral artery was excised. She was discharged after 14 days with marked improvement. Six months post-discharge, she had made a full clinical recovery. Meningiomas in pregnancy pose diagnostic and therapeutic challenges. Management must be tailored to individual patient needs. A multidisciplinary team approach is essential to optimize both maternal and fetal outcomes.