Postpartum Cerebral Angiopathy: Reversible Vasoconstriction Assessed by Transcranial Doppler Ultrasounds

Bogousslavsky, Julien; Despland, P. A.; Régli, F; Dubuis, P

doi:10.1159/000116388

Cited by 139 publications

(78 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, our case series closely resembles, clinically and angiographically, similar case studies that have been reported in association with other disorders linked to reversible vasoconstriction. These include vasculopathy in the postpartum period (15)(16)(17)(18), vasculopathy associated with pheochromocytoma (19), and that associated with the use of sympathomimetic drugs (20 -32). In each of these examples, the clinical picture is characterized by similar angiographic findings, benign spinal fluid, and a monophasic course.…”

Section: Discussionmentioning

confidence: 99%

Benign angiopathy of the central nervous system: Cohort of 16 patients with clinical course and long‐term followup

Hajj‐Ali

Furlan

Abou-Chebel

et al. 2002

Arthritis & Rheumatism

219

169

View full text Add to dashboard Cite

Objective. Benign angiopathy of the central nervous system (BACNS) is a subset of primary angiitis of the central nervous system (PACNS) with favorable outcome, not requiring prolonged immunosuppression. We retrospectively studied the clinical characteristics and prospectively assessed long-term outcome in a cohort of BACNS patients. Methods. Patients meeting the clinical description for BACNS, evaluated and treated by a single investigator, were included. Data on demographics, signs and symptoms, laboratory studies, neuroimaging, brain biopsy, treatment, and complications were recorded. The long-term assessment included a phone interview utilizing the Barthel index and a specifically designed cognitive index. Results. Sixteen cases met the inclusion criteria. Mean age was 40 years (range 10 -66 years) with female:male ratio of 4.3:1 and a mean followup period of 35 months (0 -128 months). Headache was the most common presenting symptom, seen in 88% of the cases, followed by focal symptoms (63%), and diffuse symptoms (44%). All patients had highly abnormal cerebral angiography, and magnetic resonance imaging abnormalities were present in 77% (10 of 13). Severe cerebral spinal fluid (CSF) abnormalities were present in 1 patient (7%). All followup cerebral angiography showed marked improvement. Recovery was demonstrated in 94% of the patients, 6% relapsed, and there were no deaths. Of patients assessed by the Barthel index, 71% showed no disability and 29% had mild disability. Conclusion. There is a PACNS subset characterized by acute presentation (most commonly headache), normal to mildly abnormal CSF findings, female predominance, and highly abnormal cerebral angiography (reversible after treatment), requiring less intensive treatment than has been traditionally used.

show abstract

Section: Discussionmentioning

confidence: 99%

Benign angiopathy of the central nervous system: Cohort of 16 patients with clinical course and long‐term followup

Hajj‐Ali

Furlan

Abou-Chebel

et al. 2002

Arthritis & Rheumatism

219

169

View full text Add to dashboard Cite

show abstract

“…TCD is a valid noninvasive and easily available tool that can be performed as many times as necessary to identify/quantify the severity of cerebral arterial vasoconstriction and monitor the response to treatment in follow-up. 3 We describe a case of a 41-year-old patient (gravida 5, para 1) with no complications in her current pregnancy. She was treated with norepinephrine for severe hypotension after uterine arterial disruption and cabergoline to prevent lactation after delivery.…”

Section: Letter By Martínez-martínez Et Al Regardingmentioning

confidence: 98%

“…Although the gold standard for diagnosis of PPA is digital subtraction angiography, TCD is a valid, noninvasive, and easily available tool that can be used as many times as necessary to identify/quantify the severity of the vasoconstriction as well as monitor the response to treatment on follow-up. 3 We used this method with the Lindegaard index to assess improvements and response to treatment.…”

Section: Letter By Martínez-martínez Et Al Regardingmentioning

confidence: 99%

Letter by Martínez-Martínez et al Regarding Article, “Variable Presentations of Postpartum Angiopathy”

Martínez-Martínez

Fuentes

Díez‐Tejedor

2012

Stroke

View full text Add to dashboard Cite

“…Postpartum angiopathy, a reversible cerebral vasoconstriction syndrome, is a parsimonious diagnosis linking her headache, pregnancy, elevated CSF protein, MRI findings, and encephalopathy. 2,3 However, postpartum angiopathy typically follows delivery, rather than precedes it, and often presents with vomiting and/or seizures.…”

Section: Go To Section 3 Sectionmentioning

confidence: 99%

Clinical Reasoning: A 28-year-old pregnant woman with encephalopathy

Grinspan¹,

Willey²,

Tullman³

et al. 2009

Neurology

View full text Add to dashboard Cite

A 28-year-old woman at 37 weeks' gestation became increasingly confused and forgetful. She slept 12 hours daily, mistook her apartment for previous residences, and forgot her children's names. Her husband helped her eat and walk. She presented to the obstetrical service fully dilated after 2 days of leaking vaginal fluid, and delivered a healthy baby girl. A few hours later, she did not remember giving birth. She was transferred to the neurology service for evaluation.She had had a febrile seizure at age 4, and several brief convulsions as a teenager. A sleep-deprived EEG had been negative. She took phenytoin for a year, then stopped prior to her first pregnancy. She had no further convulsions.This was her fifth pregnancy. She had 2 healthy children, 1 abruption at 23 weeks, and 1 elective abortion. Her maternal grandmother had died from a ruptured cerebral aneurysm.She had no complaints but could not explain why she was in the hospital. She was afebrile with normal blood pressure. She appeared well and had a normal postpartum abdominal examination. She was inattentive and abulic with sparse but fluent speech. She recalled 2 of 3 words at 5 minutes, but had no memory for recent events, including her delivery. She could not describe cocktail ingredients, despite working as a bartender, but correctly recited old addresses. Cranial nerves were normal. Both optic discs had sharp margins by bedside funduscopic examination. Strength was full. Reflexes were brisk, with 3 beats of clonus at her right ankle. Toes were equivocal on the right and downgoing on the left. Sensation and coordination were normal. Gait was narrow-based and slightly unsteady, but she did not fall.

show abstract

Postpartum Cerebral Angiopathy: Reversible Vasoconstriction Assessed by Transcranial Doppler Ultrasounds

Cited by 139 publications

References 12 publications

Benign angiopathy of the central nervous system: Cohort of 16 patients with clinical course and long‐term followup

Benign angiopathy of the central nervous system: Cohort of 16 patients with clinical course and long‐term followup

Letter by Martínez-Martínez et al Regarding Article, “Variable Presentations of Postpartum Angiopathy”

Clinical Reasoning: A 28-year-old pregnant woman with encephalopathy

Contact Info

Product

Resources

About