Cortical subarachnoid hemorrhage associated with reversible cerebral vasoconstriction syndrome after elective triplet cesarean delivery

Abstract

Reversible cerebral vasoconstriction syndromes (RCVS) comprise a group of disorders characterized by prolonged, but reversible vasoconstriction of the cerebral arteries, usually associated with acute-onset, severe, recurrent headaches, with or without additional neurological signs and symptoms. Various complications of this condition have been observed, such as cortical subarachnoid hemorrhages (cSAH), intracerebral hemorrhages, reversible posterior leukoencephalopathy, ischaemic strokes and transient ischaemic attacks. It is important to include RCVS in thunderclap headache differential diagnosis and among non-aneurismatic subarachnoid hemorrhage causes. In the past years, thanks to the major diffusion of new diagnostic tools such as magnetic resonance, computed tomography and digital subtraction angiography, RCVS have been demonstrated to be more frequent than previously thought. We report an illustrative case of a woman affected by a small cSAH, associated to RCVS, after elective triplet cesarean delivery. To our knowledge, this is the first case of cSAH associated to RCVS after a triplet pregnancy.

Antepartum reversible cerebral vasoconstriction syndrome with pre‐eclampsia and reversible posterior leukoencephalopathy

“…First, the onset of RCVS was during the antepartum period of pregnancy. Most of the reported pregnancy‐related RCVS cases occurred in the post‐partum period, within days to 2 weeks from delivery, hence the description, ‘post‐partum cerebral angiopathy’ . The reason for the frequent appearance of this condition in the post‐partum period is unknown.…”

“…Most of the reported pregnancy-related RCVS cases occurred in the post-partum period, within days to 2 weeks from delivery, hence the description, 'post-partum cerebral angiopathy'. 2,[9][10][11][12][13] The reason for the frequent appearance of this condition in the post-partum period is unknown. Some cases were affected during delivery, however, with exposure to vasoactive agents, such as epinephrine and methylergometrine.…”

“…Various clinical conditions are reported to be associated with RCVS, such as history of migraine, exposure to vasoactive agents, and sexual activity . Pregnancy, sometimes with pre‐eclampsia, is also one of the precipitating factors and most of the reported cases of pregnancy‐related RCVS occurred in the post‐partum period and were described as ‘post‐partum cerebral angiopathy’ . In this report, we present our experience in diagnosing and managing a case of RCVS that occurred in a pregnant woman during her antepartum period in association with pre‐eclampsia.…”

The early second-trimester multifetal pregnancy reduction improves pregnancy outcome

“…Multiple births have steadily increased in recent years because of increased usage of assisted reproductive technologies in China and other countries [1][2][3][4][5]. Compared with women with singleton and twin pregnancies, those with triplets have significantly increased risks of maternal morbidity [6], which includes gestational diabetes [7], hypertensive disorders [8], Cesarean delivery [9,10], excessive hemorrhage [11], and non-spontaneous heterotopic triplets [12]. To decrease the risks associated with triplet pregnancies, multifetal pregnancy reduction (MFPR) has been proposed [13,14].…”