Reversible cerebral vasoconstriction syndrome: a medical challenge in the peripartum period requiring a multimodal approach: a case report

Reversible cerebral vasoconstriction syndrome is a rare but potentially life-threatening neurological disorder that may occur during pregnancy and the postpartum period and represents an important diagnostic challenge because of its overlap with other obstetric neurological emergencies. We report the case of a 35-year-old woman with a dichorionic diamniotic twin pregnancy who developed severe preeclampsia requiring cesarean delivery at 30 weeks of gestation. On the fifth postpartum day, she experienced thunderclap headache, generalized seizures, and refractory cerebral vasospasm complicated by subarachnoid hemorrhage, cerebral ischemia, and intracranial hypertension. She was managed in a specialized maternal neurocritical care unit using a multimodal strategy that included continuous neuromonitoring with transcranial Doppler ultrasonography, cerebral oxygenation and metabolic monitoring, electroencephalography, intracranial pressure monitoring, serial cerebral angiography with selective intra-arterial milrinone infusion, and, ultimately, ultrasound-guided stellate ganglion block as rescue therapy. Progressive neurological recovery followed, allowing liberation from mechanical ventilation, initiation of rehabilitation, and hospital discharge with a favorable functional outcome. This case highlights the importance of considering reversible cerebral vasoconstriction syndrome in postpartum women presenting with acute neurological deterioration. Early diagnosis, multidisciplinary management, and multimodal neuromonitoring may facilitate individualized treatment and timely therapeutic escalation in patients with refractory cerebral vasospasm. Further prospective studies are needed to better define the role of advanced neuromonitoring and rescue therapies in this rare condition.