Stroke in postpartum reversible cerebral vasoconstriction syndrome

• Published in: Japanese Journal of Stroke Vol. 42; no. 4; pp. 253 - 257
• Main Authors: Watanabe, Kotaro, Okazaki, Shuhei, Taniguchi, Mariko, Kakigano, Aiko, Kitano, Takaya, Hideshima, Makoto, Ishikura, Teruyuki, Nakano, Tomohito, Jinno, Jyunki, Todo, Kenichi, Okuno, Tatsusada, Sasaki, Tsutomu, Mochizuki, Hideki
• Format: Journal Article
• Language: Japanese; English
• Published: The Japan Stroke Society 2020
• Subjects: 3-dementional T1 weighted image; basi-parallel anatomical scanning; magnetic resonance imaging; puerperium; reversible cerebral vasoconstriction syndrome
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.10726

Reversible cerebral vasoconstriction syndrome is rare but an important cause of stroke in the peripartum period. A 37-year-old-woman, who gave birth to her first child by cesarean section at 40 weeks' gestation, was transferred to the comprehensive stroke center with thunderclap headache, vertigo, and left-hand clumsiness on postpartum day 3. Magnetic resonance imaging showed multiple infarctions in the left cerebellar hemisphere and pons, and subcortical hemorrhage in the right frontal lobe. Magnetic resonance angiography (MRA) was unremarkable on admission, but follow-up MRA on day 8 revealed severe stenosis of the basilar and both vertebral arteries. Basi-parallel anatomical scanning (BPAS) and 3-dimensional-T1-weighted imaging (3D-T1WI) suggested the cause was vasospasm. She was treated with calcium antagonist, and vertebrobasilar arterial stenosis improved gradually over several months. Our case indicates that a combination of MRA, BPAS, and 3D-T1WI enables non-invasive diagnosis of reversible cerebral vasoconstriction syndrome.