Abstract
Background. A 33-year-old woman experienced a thunderclap headache immediately postpartum. The headache recurred over the next 10 days, and the patient also developed generalized tonic–clonic seizures. A subarachnoid hemorrhage was demonstrated on a head CT scan.
Investigations. Physical examination, laboratory tests, brain CT scan, brain MRI scan, brain magnetic resonance angiogram, brain magnetic resonance venogram, cerebral angiography, transcranial Doppler ultrasound, EEG.
Diagnosis. Postpartum cerebral angiopathy.
Management. NSAIds and opioid analgesics administered on postpartum day 3 provided partial headache relief. The next day, a blood patch was performed and intravenous caffeine, fluid and opioid analgesia were given to treat a suspected dural puncture headache. Following diagnosis of postpartum cerebral angiopathy on postpartum day 10, nimodipine was initiated to treat the vasospasm, and the headache was treated with opioid analgesics and toradol, followed by naproxen. The patient also received a 3-day course of intravenous magnesium sulfate.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Feske, S. K. Stroke in pregnancy. Semin. Neurol. 27, 442–452 (2007).
Trommer, B. L., Homer, D. & Mikhael, M. A. Cerebral vasospasm and eclampsia. Stroke 19, 326–329 (1988).
Qureshi, A., Frankel, M. R., Ottenlips, J. R. & Stern, B. J. Cerebral hemodynamics in pre-eclampsia and eclampsia. Arch. Neurol. 53, 1226–1231 (1996).
Geocadin, R. G., Razumovsky, A. Y., Wityk, R. J., Bhardwaj, A. & Ulatowski, J. A. Intracerebral hemorrhage and postpartum cerebral vasculopathy. J. Neurol. Sci. 205, 29–34 (2002).
Ursell, M. R. et al. Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: implications for management. Stroke 29, 1995–1998 (1998).
Bousser, M. G., Good, J., Kittner, S. J. & Silberstein, S. D. Headache associated with vascular disorders. In Wolff's Headache and Other Head Pain, 7th edn (Eds Silberstein, S. D., Lipton, R. B. & Dalessio, D. J.) 349–392 (Oxford University Press, New York, 2001).
Ducros, A. et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 130, 3091–3101 (2007).
Chandrashekaran, S., Parikh, S., Kapoor, P. & Subbarayan, S. Postpartum reversible cerebral vasoconstriction syndrome. Am. J. Med. Sci. 334, 222–224 (2007).
Edlow, B. L., Kasner, S. E., Hurst, R. W., Weigele, J. B. & Levine, J. M. Reversible cerebral vasoconstriction syndrome associated with subarachnoid hemorrhage. Neurocrit. Care 7, 203–210 (2007).
Singhal, A. B. & Bernstein, R. A. Postpartum angiopathy and other cerebral vasoconstriction syndromes. Neurocrit. Care 3, 91–97 (2005).
Sengoku, R., Iguchi, Y., Yaguchi, H., Sato, H. & Inoue, K. A case of postpartum cerebral angiopathy with intracranial hemorrhage and subarachnoid hemorrhage immediately after delivery [Japanese]. Rinsho Shinkeigaku 45, 376–379 (2005).
Mackey, K., Meyer, M. C., Stirewalt, W. S., Starcher, B. C. & McLaughlin, M. K. Composition and mechanics of mesenteric resistance arteries from pregnant rats. Am. J. Physiol. 263, R2–R8 (1992).
Hull, A. D., Long, D. M., Longo, L. D. & Pearce, W. J. Pregnancy-induced changes in ovine cerebral arteries. Am. J. Physiol. 262, R137–R143 (1992).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Chik, Y., Hoesch, R., Lazaridis, C. et al. A case of postpartum cerebral angiopathy with subarachnoid hemorrhage. Nat Rev Neurol 5, 512–516 (2009). https://doi.org/10.1038/nrneurol.2009.114
Issue Date:
DOI: https://doi.org/10.1038/nrneurol.2009.114
This article is cited by
-
A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients
Canadian Journal of Anesthesia/Journal canadien d'anesthésie (2019)
-
Reversible Cerebral Vasoconstriction Syndrome: A Review of Recent Research
Current Neurology and Neuroscience Reports (2013)
-
Postpartum RCVS and PRES with normal initial imaging findings
Acta Neurologica Belgica (2012)