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Concurrent Reversible Cerebral Vasoconstriction Syndrome and Bilateral Vertebral Artery Dissection in the Postpartum
Rong Jin1, Huiliang Melissa Tang2, Shavi Fernando1,3
1Monash University Clayton Victoria Australia.
Reports of postpartum women with concurrent reversible cerebral vasoconstriction syndrome (RCVS) and bilateral vertebral artery dissection (VAD) are rare. Guidelines on the management of future pregnancies in these patients are also limited. We present a case of a 33-year-old female who developed a severe, sudden-onset headache 2 h after a vaginal birth in a maternity hospital. The severe headaches recurred and were associated with neck pain, nausea, vomiting, and photophobia. Preliminary neuroimaging only included a noncontrast CT brain. This was normal and she was treated with triptans for presumed migraines. However, she had ongoing headaches that were refractory to treatment. On Day 14 postpartum, neuroimaging that included vessel imaging revealed multifocal vasoconstriction of the cerebral arteries (highly suggestive of RCVS), bilateral VAD, and five small cerebral infarcts. She was transferred to a tertiary hospital and treated with verapamil and aspirin, and triptans were ceased. Following her index event, the patient recovered well with no neurological sequelae apart from chronic migraine. Three years later, with effective management that included routine preeclampsia prevention, she had a safe subsequent pregnancy and birth.
Reports of postpartum women with concurrent reversible cerebral vasoconstriction syndrome (RCVS) and bilateral vertebral artery dissection (VAD) are rare. Guidelines on the management of future pregnancies in these patients are also limited. We present a case of a 33-year-old female who developed a severe, sudden-onset headache 2 h after a vaginal birth in a maternity hospital. The severe headaches recurred and were associated with neck pain, nausea, vomiting, and photophobia. Preliminary neuroimaging only included a noncontrast CT brain. This was normal and she was treated with triptans for presumed migraines. However, she had ongoing headaches that were refractory to treatment. On Day 14 postpartum, neuroimaging that included vessel imaging revealed multifocal vasoconstriction of the cerebral arteries (highly suggestive of RCVS), bilateral VAD, and five small cerebral infarcts. She was transferred to a tertiary hospital and treated with verapamil and aspirin, and triptans were ceased. Following her index event, the patient recovered well with no neurological sequelae apart from chronic migraine. Three years later, with effective management that included routine preeclampsia prevention, she had a safe subsequent pregnancy and birth.
