Impetuous expansion of pure epidural capillary hemangioma in pregnancy: A rare cause of acute paraplegia

Background: Purely epidural spinal hemangioma (PESH) represents a rare clinical entity. The majority of such reports focuses on the cavernous variety and the capillary type remains extremely rare. A minority of these lesions may cause acute clinical presentations, mostly from hemorrhage or less commonly due to tumor expansion. Acute paraplegia in pregnancy from PESH is extremely rare and may pose management dilemma. Case report: A 25-year old pregnant lady, 34 weeks into her pregnancy, presented with one-week history of paraplegia with bladder bowel involvement. On MRI, a dorsal epidural contrast enhancing mass with transforaminal extension was noted at D10-11 level. An emergency caesarean section (CS) to deliver the baby was followed by tumor excision after 48 h. The patient gradually recovered and regained 3/5 power in her lower limbs at 6 months follow up. Conclusion: PESH of capillary variety is a rare cause of acute paraplegia in pregnancy. Preoperative suspicion of this diagnosis is extremely unlikely and regardless of the timing of surgery, such acute paraplegias rarely improve completely. Fetal lung maturity is an important factor determining the surgical priority.