Download PDF
CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(01): 056-059
DOI: 10.1055/s-0042-1757912
Case Report

Peripartum Cerebral Angiopathy

Amr Sallam
1   Department of Anaesthesiology and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
,
Sebastian R. McWilliams
2   Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
,
Karl Boyle
3   Department of Stroke Medicine, Beaumont Hospital, Dublin, Ireland
,
Caroline M. Larkin
1   Department of Anaesthesiology and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Peripartum cerebral angiopathy (PCA) is a rare cerebrovascular disorder of unclear etiology that typically occurs in the first postpartum week. The aim of this case series is to present seven cases of PCA and the associated outcomes. Two of the cases were typical of a reversible cerebral vasoconstriction syndrome (RCVS) and had no long-term sequelae. Five of the cases involved intraparenchymal hemorrhage in the absence of an underlying vascular lesion, with three of the five cases having associated cerebral vasoconstriction. None of the patients had a documented history of preeclampsia or hypertension during pregnancy. It has been suggested that there is pathophysiological overlap between PCA and eclampsia and RCVS. There is limited evidence in the literature in this regard and, in most cases, treatment has been supportive only. As a condition, PCA may be under-recognized in the neurocritical care setting. Increased awareness of this condition, its manifestations, and options for management may optimize outcomes.

Keywords

peripartum - postpartum angiopathy - reversible cerebral vasoconstriction syndrome - cerebral intraparenchymal hemorrhage


Publication History

Article published online:
24 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Raps EC, Galetta SL, Broderick M, Atlas SW. Delayed peripartum vasculopathy: cerebral eclampsia revisited. Ann Neurol 1993; 33 (02) 222-225
    CrossrefPubMedSearch in Google Scholar
  • 2 Williams TL, Lukovits TG, Harris BT, Harker Rhodes C. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet 2007; 275 (01) 67-77
    CrossrefPubMedSearch in Google Scholar
  • 3 Singhal AB, Hajj-Ali RA, Topcuoglu MA. et al. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 2011; 68 (08) 1005-1012
    CrossrefPubMedSearch in Google Scholar
  • 4 Chen SP, Fuh JL, Wang SJ. et al. Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes. Ann Neurol 2010; 67 (05) 648-656
    CrossrefPubMedSearch in Google Scholar
  • 5 Ducros A, Fiedler U, Porcher R, Boukobza M, Stapf C, Bousser M-G. Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors. Stroke 2010; 41 (11) 2505-2511
    CrossrefPubMedSearch in Google Scholar
  • 6 Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser MG. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain 2007; 130 (Pt 12): 3091-3101
    CrossrefPubMedSearch in Google Scholar
  • 7 Trifu S, Vladuti A, Popescu A. The neuroendocrinological aspects of pregnancy and postpartum depression. Acta Endocrinol (Bucur) 2019; 15 (03) 410-415
    CrossrefPubMedSearch in Google Scholar
  • 8 Moussavi M, Korya D, Panezai S, Peeraully T, Gizzi M, Kirmani JF. Reversible cerebral vasoconstriction syndrome in a 35-year-old woman following hysterectomy and bilateral salpingo-oophorectomy. J Neurointerv Surg 2012; 4 (06) e35
    CrossrefPubMedSearch in Google Scholar
  • 9 Freilinger T, Schmidt C, Duering M, Linn J, Straube A, Peters N. Reversible cerebral vasoconstriction syndrome associated with hormone therapy for intrauterine insemination. Cephalalgia 2010; 30 (09) 1127-1132
    CrossrefPubMedSearch in Google Scholar
  • 10 Fugate JE, Ameriso SF, Ortiz G. et al. Variable presentations of postpartum angiopathy. Stroke 2012; 43 (03) 670-676
    CrossrefPubMedSearch in Google Scholar