Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review

Shanmugalingam, Renuka; Pour, Nina Reza; Chuah, Siang Chye; Vo, Thi Mong; Beran, Roy G.; Hennessy, Annemarie; Makris, Angela

doi:10.1186/s12884-016-0953-5

Cited by 37 publications

(36 citation statements)

References 25 publications

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“…Events most commonly occur in the postpartum period with an estimated annual incidence of 2.6–3 per 100,000 pregnancy hospitalizations [ 4 ]. VAD has been associated with HDP [ 2 , 5 ]. Leffert et al performed a national cross-sectional study of over 81 million pregnancy hospitalizations and demonstrated that women with HDP were 5.2 times more likely to have a stroke than those without HDP.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertensive disorders of pregnancy (HDP) are associated with vascular events, including stroke (Liffert et al) and cervical artery dissection [ 1 ]. However, vertebral artery dissection (VAD) is rare [ 2 , 3 ]. We describe a 31-year-old woman with a history of preeclampsia who presented 10 days postpartum with an ischemic posterior cerebellar stroke secondary to VAD.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Hypertensive disorders of pregnancy are associated with vascular complications, including ischemic stroke and cervical artery dissection. Vertebral artery dissection (VAD), however, is rare. We describe a 31-year-old female who presented with vertigo, nausea, and vomiting and was found to have a VAD. In addition, we discuss the presentation, differential diagnosis, and pathogenesis of this uncommon but clinically significant vascular event and summarize other cases of vertebral artery dissection described in the medical literature. Case presentation A 31-year-old Hispanic woman presented 10 days postpartum with a one-day history of vertigo, nausea, vomiting, and frontal headache. The patient’s pregnancy course had been complicated by preeclampsia, chorioamnionitis, and iron-deficiency anemia, and her delivery was complicated by acute hemorrhage. Physical examination was significant for left leg ataxia. Laboratory studies showed marked thrombocytosis. Emergent computed tomography (CT) scan of the head was obtained and revealed a left cerebellar ischemic large vessel stroke. Subsequent CT angiography of the head and neck showed a left VAD. Based on correlation of the clinical history and laboratory and imaging findings, a diagnosis of vertebral artery dissection secondary to reactive (secondary) thrombocytosis from overlapping iron-deficiency anemia and acute hemorrhage was established. The patient was started on a heparin infusion and experienced significant improvement after a four-day hospitalization. Conclusion VAD is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women aged 30 years or older and those with a history of a hypertensive disorder of pregnancy are at particularly high risk. Prompt diagnosis and management of VAD is essential to ensure favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of cervical carotid, vertebral and intracranial artery dissection in association with preeclampsia [ 46 ]. Headache is the most frequent inaugural symptom, described as severe, unilateral (ipsilateral to the dissected vessel), with a sudden (even thunderclap) onset.…”

Section: Clinical Headache Phenotypes and Observational Studies In Prmentioning

confidence: 99%

Headache and pregnancy: a systematic review

et al. 2017

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This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify “red flag symptoms” suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.

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“…Outside of pregnancy, cervical artery dissections are usually treated with either a vitamin K antagonist or antiplatelet (acetylsalicylic acid) for 3-6 months. Case reports of women treated for carotid and vertebral dissections occurring in both the antenatal and early post-partum period indicate the same management strategies are used [57][58][59][60] without reported adverse effects for the mother or infant. Both aspirin and warfarin were used for secondary prevention among 68 women who had suffered a previous CVST prior to pregnancy.…”

Section: D Pre-existing Diabetes and Gestational Diabetes For Strokmentioning

confidence: 99%

Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy

Swartz

Ladhani

Foley

et al. 2017

International Journal of Stroke

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The Canadian Stroke Best Practice Consensus Statement: Secondary Stroke Prevention during Pregnancy, is the first of a two-part series devoted to stroke in pregnancy. This document focuses on unique aspects of secondary stroke prevention in a woman with a prior history of stroke or transient ischemic attack who is, or is planning to become, pregnant. Although stroke is relatively rare in this cohort, several aspects of pregnancy can increase stroke risk during or immediately after pregnancy. The rationale for the development of this consensus statement is based on the premise that stroke in this group requires a specifically-tailored management approach. No other broad-based, stroke-specific guidelines or consensus statements exist currently. Underpinning the development of this document was the concept that maternal health is vital for fetal wellbeing; therefore, management decisions should be based on the confluence of two clinical considerations: (a) decisions that would be made if the patient was not pregnant and (b) decisions that would be made if the patient had not had a stroke. While empirical research in this area is limited, this consensus document is based on the best available literature and guided by expert consensus. Issues addressed in this document include general management considerations for secondary stroke prevention, the use of antithrombotics, blood pressure management, lipid management, diabetes care, and management for specific ischemic stroke etiologies in pregnancy. The focus is on maternal and fetal health while minimizing risks of a recurrent stroke, through counseling, monitoring, and the safety of select pharmacotherapy. These statements are appropriate for health care professionals across all disciplines.

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Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review

Cited by 37 publications

References 25 publications

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

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

Headache and pregnancy: a systematic review

Canadian stroke best practice consensus statement: Secondary stroke prevention during pregnancy

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