Postpartum cerebral arterial dissections

Abstract

Postpartum cerebral arterial dissections are rare, and the clinical features, diagnosis, and treatment approaches are not clear to many physicians. This study was to investigate the clinical features, diagnosis, and treatment of postpartum cerebral arterial dissections.One patient with postpartum cerebral arterial dissections enrolled in our hospital was analyzed. All patients with postpartum cerebral arterial dissections retrieved from the PubMed were also included in this study and analyzed.A total of 45 patients with postpartum cerebral arterial dissections were retrieved including our case, with an age range of 24 to 44 years (mean 34). Thirty-six (80%) patients were older than 30 years of age (mean 35). There were 17 cases of cesarean section, 14 cases of natural labor, and 14 cases whose delivery modes were not reported. The clinical symptoms included headache in 35 cases (78%) and neck pain in 14 (31%). The symptoms occurred at a mean time of 11 days (range 0-53 days) following delivery. Among 45 patients, arterial dissections involved unilateral carotid or vertebral artery in 29 cases (64%), bilateral carotid or vertebral arteries in 8 (18%), 3 arteries in 3 (7%), and all bilateral carotid and vertebral arteries in 5 (11%). Fourteen (31%) patients were treated with antiplatelet agents, 27 (60%) with anticoagulation, 7 (16%) with both antiplatelet and anticoagulation medications, and only 2 (4%) with stent angioplasty. The prognosis was complete recovery in 30 (86%) patients and mild focal neurological symptoms in 5 (14%).Postpartum cerebral arterial dissections are rare, and correct diagnosis relies on imaging examination. Prognosis is usually favorable in patients with early diagnosis and prompt treatment.

Response-monitored dual anti-platelet treatment in a patient with spontaneous post-partum four-vessel cervical artery dissection

“…While in some patients with symptomatic CAD it is possible to identify a causal factor the majority may be due to transient vasculopathies [ 1 ]. In the presented patient the most likely cause was the delivery associated with tension and Valsalva, although the exact pathophysiological process remains unknown [ 8 ].…”

Postpartum complications following neuraxial anaesthesia for obstetric physicians

“…Features suggestive of SCAD include severe headache (78%) ipsilateral to the Horner's syndrome, pulsatile tinnitus, symptoms or signs of anterior circulation stroke, and delayed presentation with onset a mean time of onset 11days (range 0-53 days) following delivery. 45 SCAD may be diagnosed using MR or CT angiography.…”

Transcarotid Artery Revascularization (TCAR): The Best Surgical Intervention Option in an Unusual Presentation of Carotid Dissection in a 37-Year-Old Pregnant Female

“…CAD can occur in any age group; however, it is most commonly associated with cerebrovascular accident (CVA) in patients in their early 40s with a higher prevalence in males [1]. Carotid artery dissection is a rare condition but has recently caused 6% of spontaneous carotid dissection in postpartum patients with an association with advanced maternal pregnancy age (>30 years old) [2]. Due to the rarity of this condition, a carotid artery dissection can be commonly missed in these patients until the patient presents with ischemic stroke symptoms or severe neurological deficits [2,3].…”

“…Carotid artery dissection is a rare condition but has recently caused 6% of spontaneous carotid dissection in postpartum patients with an association with advanced maternal pregnancy age (>30 years old) [2]. Due to the rarity of this condition, a carotid artery dissection can be commonly missed in these patients until the patient presents with ischemic stroke symptoms or severe neurological deficits [2,3]. Ipsilateral head and neck pain with associated Horner's syndrome or transient ischemic attack are all signs indicating potential carotid artery dissection; however, headache and neck pain are the two most common symptoms present in 60%-90% of cases with postpartum carotid artery dissection [2,3].…”

“…Due to the rarity of this condition, a carotid artery dissection can be commonly missed in these patients until the patient presents with ischemic stroke symptoms or severe neurological deficits [2,3]. Ipsilateral head and neck pain with associated Horner's syndrome or transient ischemic attack are all signs indicating potential carotid artery dissection; however, headache and neck pain are the two most common symptoms present in 60%-90% of cases with postpartum carotid artery dissection [2,3]. Most cases are linked to pregnancy with an increased association with postpartum without any predisposing risk factors [3].…”