1183. Postpartum Reversible Vasoconstriction Syndrome Presenting with Intracranial Lobar Hemorrhage: Case Report and Review of the Literature

Authors: Adesh Tandon, MD, FAANS; Khalid Sethi, MD; Yahai Lodi, MD; Elwaleed Elnour, MD (Johnson City, NY)

Introduction:

The authors present the case of a 31 y/o female who was 3 weeks postpartum, who presented with symptoms of worsening headaches and left upper extremity numbness for 1 weeks duration.  CT scan of the brain revealed a 3.5 by 3.5 cm right frontal intra-parenchymal hemorrhage with minimal mass effect or midline shift.  The patient remained overall neurologically stable with only subjective numbness.  CT angiogram of the brain did not reveal any evidence of vascular malformation or venous sinus thrombosis.  Cerebral angiography revealed diffuse vasculitis throughout the right anterior circulation distribution especially in the area of the known hemorrhage.  Given the findings on the cerebral angiogram, the patient was given the diagnosis of postpartum reversible vasoconstriction syndrome.  The patient was managed on high dose IV steroids and discharged home in stable condition.    

Methods:

Case Report

Results:

Case Report

Conclusion:

     Postpartum Reversible Vasoconstriction Syndrome (PPVCS) is a relatively rare angiopathy that falls into the category of Reversible Cerebral Vasoconstriction Syndromes (RCVS).  These conditions typically present with multi-focal narrowing of cerebral vasculature causing varying degrees of symptoms.  These symptoms can be isolated to headaches, or progress to focal neurologic deficits secondary to brain edema, brain ischemia, and or cerebral hemorrhage. Risk factors for RCVS include pregnancy, migraine headaches, use of vasoconstrictive medications, and prior neurological surgery.  Prevalence of PPVCS is not well documented, but postpartum headaches can be prevalent in up to 40% of postpartum patients.
    The authors will discuss the pathophysiology of PPVCS and review the current literature.  Given the high prevalence of postpartum headaches, the authors will recommend screening parameters as well.