Postpartum extracranial bilateral vertebral artery dissection mimicking subarachnoid hemorrhage

Spontaneous vertebral artery dissection (VAD) is a rare condition and can potentially cause a stroke, particularly in young to middle-aged people. Bilateral extracranial VAD is extremely rare.

A 37-year-old woman complained of severe headache 1 hour postpartum. Her pain was relieved with medication and she was subsequently discharged. Three days later, the patient returned with worsening headache that she described as the worst headache of her life. Computed tomography and lumbar puncture was negative for subarachnoid hemorrhage. Magnetic resonance angiography showed bilateral extracranial vertebral artery occlusion. The patient remained stable with conservative therapy without further worsening of headache or any new neurological deficits.

This is the first reported case of bilateral extracranial VAD in an immediate postpartum woman in the literature. The postpartum state is a risk factor for clinically relevant dissection, and this diagnosis should be considered. Outcomes for vertebral arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note severe, atypical headache or neck pain.