Postpartum Angiopathy With Reversible Posterior Leukoencephalopathy

Abstract

These cases, and the literature, suggest an interrelationship between RPLS and cerebral vasoconstriction syndromes such as PPA.

Hemorrhage in Posterior Reversible Encephalopathy Syndrome: Imaging and Clinical Features

“…Although the incidence of hemorrhage in our PRES population (15.2%) is similar to that in previous reports, 5,8,36 our data demonstrate a number of new and important observations.…”

“…Prior studies have demonstrated parenchymal hematoma or sulcal subarachnoid hemorrhage in 5%-17% of patients with PRES, 5,8,36 but the mechanism behind hemorrhage in PRES is equally unclear. Doss-Esper et al 37 have proposed 2 hypotheses: 1) nonaneurysmal subarachnoid (sulcal) hemorrhage due to rupture of pial vessels in the face of severe hypertension and impaired cerebral autoregulation, and 2) postischemic reperfusion injury leading to multifocal brain hemorrhages.…”

Reversible Cerebral Vasoconstriction Syndrome, Part 1: Epidemiology, Pathogenesis, and Clinical Course

“…11 It has been postulated that vasoconstriction of small arterioles early in the course of RCVS, along with hypertension and breakdown of autoregulatory mechanisms, may precipitate the rupture of small pial vessels with resulting subarachnoid hemorrhage. 17,59,62 Other patterns of intracranial hemorrhage encountered in RCVS include intraparenchymal hemorrhage and subdural hematomas. 1,8,57,59,63 Intraparenchymal hemorrhage can be see in up to 6%-20% of patients and most often is unifocal and lobar in location.…”

Treatment of Acute Ischemic Stroke: Beyond Thrombolysis and Supportive Care

“…Some cases may recover spontaneously [42]. Optimal treatment has not been clearly established; however, agents used have included calcium channel blockers to treat vasospasm (particularly nimodipine and verapamil), magnesium (in the postpartum period) and high-dose steroids [42][43][44][45][46]. Patients should have follow-up vascular imaging to determine the evolution of their vasoconstriction.…”