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
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20183358Keywords:
Angiopathy, Cerebral artery, Postpartum, Reversible, VasoconstrictionAbstract
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.
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References
Fugate JE, Ameriso SF, Ortiz G, Schottlaender LV, Wijdicks EF. Variable presentations of postpartum angiopathy. Stroke. 2012;43:670-6.
Ducros A, Bousser MG. Reversible cerebral vasoconstriction syndrome. Pract Neurol. 2009;9:256-67.
Ducros A, Boukobza M, Porcher R, Sarov M, Valade D. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain. 2007;130:3091-101.
Jaigobin C, Silver FL. Stroke and pregnancy. Stroke. 2000;31:2948-51.
Calabrese LH, Dodick DW, Schwedt TJ, Singhal AB. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146:34-44.
Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol. 2006;5:621-31.
Newell CP, Seller C, Vizhi M, Turner N. Case report: Spontaneous coronary artery dissection during elective caesarean section under spinal anaesthesia. Anaesthesia. 2011;66:615-9.
Geocadin RG, Razumovsky AY, Wityk RJ, Bhardwaj A, Ulatowski JA. Intracerebral hemorrhage and postpartum cerebral vasculopathy. J Neurol Sci. 2002;205(1):29-34.
Neudecker S, Stock K, Krasnianski M. Call-Fleming postpartum angiopathy in the puerperium: a reversible cerebral vasoconstriction syndrome. Obstet Gynecol. 2006;107:446-9.
Chartier JP, Bousigue JY, Teisseyre A, Morel C, Delpuech-Formosa F. Postpartum cerebral angiopathy of iatrogenic origin. Rev Neurol. 1997;153(3):212-4.
Konstantinopoulos PA, Mousa S, Khairallah R, Mtanos G. Postpartum cerebral angiopathy: An important diagnostic consideration in the postpartum period. Am J Obstet Gynecol. 2004;191(1):375-7.
Singhal AB, Hajj-Ali RA, Topcuoglu MA. Reversible cerebral vasoconstriction syndromes: Analysis of 139 cases. Arch Neurol. 2011;68:1005-12.
Thiex R, Norbash AM, Frerichs KU. The safety of dedicated-team catheter-based diagnostic cerebral angiography in the era of advanced noninvasive imaging. AJNR Am J Neuroradiol. 2010;31:230-4.
Soltanolkotabi M, Ansari SA, Shaibani A, Singer TB, Hurley MC. Spontaneous post-partum cervical carotid artery dissection in a patient with reversible cerebral vasoconstriction syndrome. Interv Neuroradiol. 2011;17:486-9.
Geraghty JJ, Hoch DB, Robert ME, Vinters HV. Fatal puerperal cerebral vasospasm and stroke in a young woman. Neurol. 1991;41:1145-7.
Akhter T, Larsson A, Larsson M, Wikström AK, Naessen T. Artery wall layer dimensions during normal pregnancy: A longitudinal study using noninvasive high-frequency ultrasound. Am J Physiol Heart Circ Physiol. 2013;304:H229-34.
Chen SP, Fuh JL, Wang SJ. Reversible cerebral vasoconstriction syndrome: An under-recognized clinical emergency. Therapeutic Advances in Neurological Disorders. 2010;3(3):161-71.
Karmacharya R, Singh M, Rawal S. Call Fleming syndrome: Case report. Nepal J Neurosci. 2008;5:60-1.
Cvetanovich GL, Ramakrishnan P, Klein JP, Rao VR, Ropper AH. Reversible cerebral vasoconstriction syndrome in a patient taking citalopram and hydroxycut: A case report. J Med Case Rep. 2011;5:548.
