Hyperemesis Gravidarum: An Out of the Box Presentation, a Rare Case Report and Literature Review

Sangeetha Tharian, Nayana George, Benjamin Tharian, Kavitha Tharian, Benny Paul, Valsamma Chacko


Infratentorial ependymoma presenting as hyperemesis gravidarum during pregnancy is not reported in the literature. The management of these rare infratentorial tumors during pregnancy poses a great challenge to the obstetrician, since the physiological and hormonal changes of pregnancy can exacerbate the symptoms of the tumor and pose varying risks to both the mother and the fetus. We report a case of an infratentorial ependymoma presenting as hyperemesis gravidarum at 24 weeks of gestation. A 36-year-old diabetic woman was admitted with persistent vomiting at 24 weeks of gestation with a provisional diagnosis of hyperemesis gravidarum. She had history of hyperemesis gravidarum throughout the antenatal period and was on regular follow-up by obstetrician and physician. She developed features of intracranial hypertension and bilateral abducent nerve palsy during hospital stay. An MRI scan of the brain revealed a tumor of the fourth ventricle causing obstructive hydrocephalus. An emergency ventriculoperitoneal shunt was done to relieve the intracranial pressure. Subsequently, she underwent a suboccipital craniotomy with complete removal of the tumor. Histopathology was consistent with ependymoma. During the postoperative period, she developed stridor and dyspnoea and was ventilated. Intrauterine death of the fetus was confirmed by ultrasonology as there was cessation of the fetal heart sound. A hysterotomy was done to remove the fetus as an induction of labor failed. She subsequently developed ventilator associated pneumonia and adult respiratory distress syndrome followed by septicemia and expired on the 12th postoperative day despite appropriate antibiotics and other supportive measures. To our knowledge, this is the first reported case of infratentorial ependymoma presenting during pregnancy. Intracranial tumors, especially infratentorial tumors during pregnancy, are associated with high maternal and fetal morbidity and mortality as they behave differently from supratentorial tumors. A definite protocol for the management of pregnant patients with infratentorial tumors is lacking as there are only few reported cases. Early detection and treatment plays an important role in the management of these tumors.

J Clin Gynecol Obstet. 2014;3(4):143-146
doi: http://dx.doi.org/10.14740/jcgo287w


Infratentorial tumor; Ependymoma; Hyperemesis gravidarum; Intracranial hypertension

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics






Journal of Clinical Gynecology & Obstetrics, quarterly, ISSN 1927-1271 (print), 1927-128X (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal, the authors retain the copyright, the journal is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International
License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.jcgo.org   editorial contact: editor@jcgo.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.