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