Delayed angiographic changes in postpartum cerebral angiopathy

Area of Science:

• Neurology
• Radiology
• Vascular Neurology

Background:

• Postpartum cerebral angiopathy (PCA) is a recognized subset of reversible cerebral vasoconstriction syndromes (RCVS).
• A temporal delay between clinical presentation and angiographic evidence of vasoconstriction in PCA is increasingly noted.
• RCVS encompasses various conditions characterized by temporary narrowing of cerebral arteries.

Observation:

• A patient experienced severe thunderclap headaches, vertigo, and a seizure 19 days postpartum.
• The patient's neurological symptoms preceded the detection of extensive cerebral vasoconstriction on MRA imaging.
• The observed vasoconstrictive changes demonstrated reversibility over a 3-month period.

Findings:

• The clinical syndrome of postpartum cerebral angiopathy manifested 15 days before angiographic confirmation.
• Magnetic Resonance Angiography (MRA) revealed significant vasoconstriction consistent with RCVS.
• Complete radiological resolution of vasoconstriction was achieved by 3 months postpartum.

Implications:

• This case underscores the importance of considering PCA in postpartum women presenting with severe headaches, even with an initial negative angiogram.
• The delayed onset of angiographic findings in PCA necessitates serial imaging and clinical monitoring.
• Understanding the temporal dynamics of PCA is crucial for accurate diagnosis and management of postpartum neurological emergencies.