Reversible cerebral vasoconstriction syndrome in puerperium: A prospective study

Area of Science:

• Neurology
• Obstetrics
• Vascular Neurology

Background:

• Reversible Cerebral Vasoconstriction Syndrome (RCVS) presents with severe thunderclap headaches and reversible cerebral artery vasoconstriction.
• Puerperium is a known trigger for RCVS, but its incidence remains largely unknown.
• Understanding the incidence and characteristics of postpartum RCVS is crucial for maternal health.

Purpose of the Study:

• To prospectively determine the incidence of RCVS in the puerperium.
• To identify risk factors and clinical features associated with puerperal RCVS.
• To evaluate the diagnostic utility of Transcranial Colour Coded Sonography (TCCS) in detecting early vasospasm.

Main Methods:

• Prospective enrollment of 900 consecutive women within three days of delivery.
• Collection of medical history, demographic, anthropometric, and biological data.
• Assessment of cerebral artery vasospasm using Transcranial Colour Coded Sonography (TCCS) and a one-month follow-up interview.

Main Results:

• Thunderclap headache was reported by 0.9% of subjects during the initial visit and an additional 3.4% by one month, totaling 3.8% with at least one episode.
• The overall incidence of puerperal RCVS following uncomplicated pregnancy and delivery was found to be negligible at 0.1%.
• The vast majority (97%) of thunderclap headaches experienced postpartum had a benign clinical course, with one confirmed RCVS case having a favorable outcome.

Conclusions:

• The risk of developing Reversible Cerebral Vasoconstriction Syndrome (RCVS) in the puerperium following normal pregnancies and uncomplicated deliveries is very low (0.1%).
• A significant proportion of postpartum women (3.4%) may experience thunderclap headaches, but these are typically benign.
• Transcranial Doppler sonography can be a valuable tool for identifying patients who may require further neuroradiological investigation for suspected RCVS.