Bilateral Vertebral Artery Dissections Associated With Postpartum Preeclampsia: A Case Report

Postpartum vertebral artery dissections (VADs) are infrequently reported; although data are limited, several case reports describe VAD occurring in the setting of postpartum preeclampsia. We present a 39-year-old G3P3003 (P1 term stillbirth) who developed bilateral VADs in the setting of postpartum preeclampsia and a persistent, nonfocal occipital headache. Six days after an uncomplicated cesarean delivery, the patient developed an unrelenting occipital headache accompanied by severe-range blood pressures. She met diagnostic criteria for postpartum preeclampsia. Despite treatment with magnesium sulfate and antihypertensives, her headache persisted. On postpartum day 9, she developed new neck pain in addition to her headache. Computed tomography angiography revealed bilateral VADs. She was initiated on dual antiplatelet therapy, systemic anticoagulation, and strict blood pressure control. Her neurologic examination remained nonfocal throughout admission. Over subsequent days, her blood pressure normalized and her headache improved. This case highlights the diagnostic challenges of evaluating postpartum headaches and underscores the importance of ongoing reassessment rather than anchoring to an initial diagnosis. It also raises the question of whether VAD precipitates hypertensive episodes or whether postpartum preeclampsia contributes to arterial injury.