From Spinal Meningioma to Compressive Hematoma: A Case of Spontaneous Spinal Hematoma Mimicking Meningioma in a Pregnant Woman.

Spontaneous spinal hematomas are rare but potentially life-threatening, particularly during pregnancy, where they can mimic other spinal lesions, complicating diagnosis and management. We report a case of a 26-year-old pregnant woman at 23 weeks of gestation, who presented with sudden-onset paraparesis. Neurological examination revealed signs of spinal cord compression, and MRI suggested a spinal meningioma due to an extramedullary tissue process at the D3-D4 level. Despite a normal coagulation profile, emergency laminectomy (D2-D6) was performed, revealing and evacuating a spontaneous spinal hematoma. No active bleeding source or vascular malformation was identified, and fetal assessments remained stable. The pathophysiology of spontaneous spinal hematomas in pregnancy is multifactorial, involving increased vascular fragility due to pregnancy-induced hemodynamic and hormonal changes, including elevated estrogen and progesterone levels and a hypercoagulable state. Additionally, increased intra-abdominal pressure from the gravid uterus may contribute by exacerbating spinal venous congestion. Distinguishing spinal hematomas from meningiomas is challenging due to overlapping clinical and imaging features; however, the sudden onset of symptoms and characteristic MRI signal patterns can aid in differentiation. This case underscores the importance of considering spontaneous spinal hematoma in pregnant patients with acute neurological symptoms. Early recognition and timely surgical decompression are essential to prevent irreversible neurological deficits and optimize maternal and fetal outcomes. Further research is needed to better understand the underlying mechanisms and improve management strategies for this rare but serious condition.