Abstract
Background: Headache is one of the most common symptoms encountered during the postpartum period. The cause may be unknown or the following illnesses are possible. Cervical artery dissection (CAD), and reversible posterior cerebral encephalopathy syndrome (PRES) and reversible cerebral vasoconstrictor syndrome (RCVS). It is suggested that they are interrelated and share a similar mechanism such as small vessel endothelial dysfunction, deficiencies in self-regulation, and decreased sympathetic innervation of the posterior circulation. However, there are few reports of neuroradiological findings. We experienced a rare case of multiple postpartum vascular disease occurring at the same time.
Case Report: A 38-year-old woman suddenly developed thunderclap headache after giving birth. She was clear and had no neuropathy. Computed tomography revealed subarachnoid hemorrhage, including the cortical surface of the frontal lobe. Magnetic resonance image fluid-attenuated inversion recovery revealed high-intensity area in the bilateral basal ganglia and right occipital cortex. Angiography showed ”string sausage” and extracranial left vertebral artery stenosis, but no aneurysm. Based on the clinical course and neuroradiological findings, we diagnosed her as postpartum vascular disease including CAD, PRES, RCVS, and cortical SAH. Three-dimensional black blood T1-weighted images using a motion-sensitized driven equilibrium three-dimensional turbo spin echo (MSDE) sequencing method revealed an intramural hematoma consistent with the extracranial vertebral artery. After three months, MSDE lost its abnormal signal.
Conclusion: Our case was rare in that multiple phenomena of postpartum vascular disease occurred at the same time. In particular, we could reveal that this speculation was reversible in the MRI MSDE sequencing.
MeSH Keywords: cervical artery dissection, reversible cerebral segmental vasoconstriction, post-partum, reversible posterior cerebral encephalopathy syndrome, motion-sensitized balanced three-dimensional turbo spin echo