Progressive Nausea and Vomiting in Pregnancy: Eliminate Neurological Causes-A Case Report

Abstract

Background: Severe nausea and vomiting in the first and second trimester of pregnancy is often diagnosed as hyperemesis gravidarum (HG), although true HG only appears in very few pregnancies. Anchoring, the tendency for clinicians to stick with an initial diagnosis even as new information becomes available, can lead to hesitation to perform MR-imaging in pregnant patients. As prompt diagnosis of intracranial neoplasm increases the chance on a favourable outcome, awareness among doctors is needed. Scant data on pregnant patients diagnosed with brain tumours is available; this case report pays attention to possible pitfalls for doctor’s delay. Case summary: A 36-year-old G2PO presented with severe nausea, vomiting and vertigo in the first and second trimester of pregnancy after IVF-treatment. An increase of symptoms, headaches and a lurched walking pattern were initially attributed to dehydration, orthostatic hypotension and later to a proven B12 deficiency. When symptoms worsened despite vitamin suppletion and drowsiness and bradyphrenia developed, a MR-scan of the brain showed severe obstructive hydrocephalus caused by a mass in the fourth ventricle. Surgical resection of a ganglioglioma (WHO grade I) was performed at a gestational age of 25 weeks. Conclusion: HG typically resolves around the 20th week of gestation, therefore persistent nausea and vomiting during pregnancy warrants a cerebral MR-scan in order to exclude neurological causes.