An unusual case of reversible cerebral vasoconstriction syndrome presenting during antepartum period

Abstract

An unusual case of reversible cerebral vasoconstriction syndrome presenting during antepartum periodSir, A 29-year-old primigravida of 34 weeks amenorrhea was referred with the complaints of severe episodic headaches, vomiting and status epilepticus after emergency cesarean section from gynecology services for evaluation. History was negative for fever, hypertension, trauma, pedal edema, abortions/fetal loss or epilepsy and she had regular antenatal care. On examination, she was stuporous with left hemiparesis and bilateral plantar extensor. Magnetic resonance imaging (MRI) brain revealed multiple large acute intrparenchymal hemorrhages: Right frontal lobe (4 × 3.8 × 2.9 cm), left superior frontal lobe (1.2 × 1 cm) and left temporo-occipital lobe (1.4 × 2 cm) with intraventricular extension [ Figure 1a and b]. Fluid-attenuated inversion recovery sequence also revealed subarachnoid hemorrhage (SAH) [ Figure 1c]. MR-angiography (MRA) revealed marked diffuse narrowing of supraclinoid segments of bilateral internal carotid arteries, proximal bilateral M1 segment of middle cerebral artery, A1 segment of anterior cerebral artery and P1 segment of posterior communicating artery [ Figure 1d] with no evidence of cerebral aneurysm. MR-venogram (MRV) was normal. With a working diagnosis of reversible cerebral vasoconstriction