A Case of Reversible Cerebral Vasoconstriction Syndrome: Postpartum Cerebral Angiopathy in a 32-Year-Old Primigravid Treated with Intravenous Immunoglobulin

This is a case of a 32-year-old primigravid who developed sudden severe headache on the 7th day postpartum associated with focal neurologic deficits and altered sensorium. She had a GCS score of 6, anisocoric pupils and an NIHSS score of 31. Cranial MRI with MRA showed multifocal hyperacute to acute infarcts on the left occipital lobe, left thalamus, and midbrain which was more prominent on the right. Due to clinical deterioration, a repeat Cranial MRI with MRA was done and showed progression of infarcts involving both thalami and right pons with interval appearance of contour irregularities in the proximal anterior cerebral, posterior cerebral, basilar and internal carotid arteries. Serial transcranial Doppler showed significant distal right middle cerebral artery vasospasm. She was managed as a case of reversible cerebral vasoconstriction syndrome, associated with postpartum cerebral angiopathy. Intravenous pulse methylprednisolone was started subsequently IVIG was initiated. Intravenous immunoglobulin was given for 5 days. The patient gradually improved, underwent rehabilitation therapy, and was discharged stable after 6 weeks.

Curious case of corpus callosal hematoma in a normotensive post-partum female patient: a case report of reversible post-partum angiopathy with clinico-radiological correlation

Postpartum cerebral angiopathy (PCA) is a rare cause of stroke in the puerperium. It usually presents with episodes of headache, seizures and neurological deficits in early post-partum period in normotensive females. CT, MRI and catheter angiography may demonstrate segmental vasoconstriction that often resolves spontaneously. PPA is generally regarded as a benign, non-relapsing and reversible disease process. We present a clinico-radiological correlative case of isolated corpus callosal hematoma in a post-partum normotensive female with evidence of intracranial vascular spasm and luminal irregularity on CT and catheter angiography. Follow up MR angiography showed resolution of the vasospasm and luminal irregularity. Patient was managed conservatively and showed resolution of the symptoms in follow up visit on 8th week.