Postpartum vertebral artery dissection with posterior reversible encephalopathy syndrome

Abstract

We diagnosed postpartum eclampsia with posterior reversible encephalopathy syndrome (PRES) in a 35-year-old woman who began experiencing headaches after delivery. Cervical MR angiography (MRA) suggested concomitant vertebral artery (VA) dissection. Antiplatelet therapy was not indicated. Each episode resolved spontaneously. The patient subsequently developed sudden onset of thunderclap headache. She experienced a tonicoclonic seizure in the outpatient clinic. On the basis of clinical course and MRI, we diagnosed postpartum eclampsia with PRES. Antiplatelet therapy was not indicated, as there were no signs of stroke. Antiepileptic and antihypertensive medicines were used for a short term to control seizure and blood pressure. Subsequent MRI 17 days after discharge showed resolution of the abnormal signals, but the intramural heme signals became apparent on the dissecting segment of VA. Subsequent MRI after 3 months indicated resolution of arterial dissection. To the best of our knowledge, this represents the third report of postpartum cervicocephalic artery dissection with PRES in the literature.

Postpartum vertebral artery dissection: case report and review of the literature

“…Aortic, cervical, and coronary artery dissection in the postpartum state have been described in the medical literature [ 7 ]. However, to our knowledge, there are only 11 previously reported cases of isolated VAD in the postpartum state (Table 1 ) [ 2 – 4 , 8 – 11 ]. Headache or neck pain has been present in every case report of isolated postpartum VAD.…”

Postpartum Reversible Cerebral Vasoconstriction with Cortical Subarachnoid Hemorrhage and Posterior Reversible Encephalopathy Syndrome Concomitant with Vertebral Artery Dissection Diagnosed by MRI MSDE Method; A Case Report and Review of Literature.

“…One case had PRES based on FLAIR highintense area in the bilateral occipital area. 34 Previous reports indicate that 8-12% of RCVS patients have CAD. 13,37 Wiebers et al described the rst case of a 44-year-old woman with postpartum CAD in 1985.…”

“…To the best of our knowledge, 26 women and 35 dissections have described postpartum patients with CAD, including our patient (Table 1). [25][26][27][28][29][30][31][32][33][34][35][36] The mean age was 35 years (range, 26-44 years); the mean time from birth to onset was 10.5 days (range, 1 hour-53 days). For CAD-affected lesions, 15 (57%) women had a single lesion and the other women (43%) had multiple lesions.…”

Is cervicocephalic dissection a part “postpartum vasculopathy” spectrum? A case of postpartum posterior reversible encephalopathy syndrome, bilateral petrous carotid artery dissections, and stroke

“…[4,5] An association between PRES and cervicocephalic artery dissection is extremely rare, with only three cases being reported in the literature till date. [4,6] We report the fourth case of cervicocephalic artery dissection following PRES.…”

“…[1] Only a few reports of MRS have been reported in literature. [1][2][3][4][5][6] A few cases have, however, been seen with meningitis caused by West Nile and HSV-1 virus meningitis, as well as with listeria and tuberculous meningitis. We report a case of MRS associated with HSV-1 meningitis.…”