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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
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Postpartum RCVS and PRES with normal initial imaging findings.

Robin Lemmens1, Stephanie Smet, Guido Wilms

  • 1Laboratory for Neurobiology, Experimental Neurology, KU Leuven, and Vesalius Research Center, VIB, Leuven, Belgium. robin.lemmens@vib-kuleuven.be

Acta Neurologica Belgica
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Summary

Postpartum angiopathy, a form of reversible cerebral vasoconstriction syndrome, can present with severe headache. This case highlights that diagnosis is crucial even if initial imaging is normal.

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Area of Science:

  • Neurology
  • Radiology
  • Obstetrics

Background:

  • Postpartum angiopathy is a rare neurological condition.
  • It is a clinical presentation of reversible cerebral vasoconstriction syndrome (RCVS).
  • RCVS involves temporary narrowing of brain arteries.

Observation:

  • A patient presented with thunderclap headache postpartum.
  • Initial diagnostic tests, including angiography, were normal.
  • Neurological status worsened, with imaging showing posterior reversible encephalopathy syndrome, stroke, and arterial narrowing.

Findings:

  • The patient experienced a complete recovery.
  • Focal vasoconstriction resolved spontaneously.
  • Delayed imaging revealed characteristic RCVS changes.

Implications:

  • Postpartum angiopathy diagnosis should be considered in women with thunderclap headaches, even with initial normal imaging.
  • The presentation of RCVS can be variable and evolve over time.
  • This case emphasizes the importance of serial imaging and clinical monitoring.