Postpartum reversible cerebral vasoconstriction syndrome confined to the bilateral cervical vertebral arteries
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LETTER TO THE EDITOR
Postpartum reversible cerebral vasoconstriction syndrome confined to the bilateral cervical vertebral arteries Ho Geol Woo 1 & Jiwook Ryu 2 & Chi Hyuk Oh 3 & Jae Hong Lee 4 & Jin San Lee 1 Received: 28 July 2020 / Accepted: 17 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches that reach peak pain intensity in seconds to minutes and reversible multi-segmental constriction of the cerebral arteries. Besides acute onset severe headache, clinical manifestations of RCVS include seizures, focal neurological deficits related to transient ischemic attacks, stroke presenting as hemiplegia, aphasia, hemianopia, or cortical blindness. In general, arterial involvement in most patients with RCVS is bilateral, and diffuse multi-segmental vasoconstriction in the anterior and posterior circulations is seen, and almost all cases are related to arterial dissection when the cervical arteries are involved [1]. Herein, we report the case of a patient with postpartum RCVS confined to the bilateral cervical vertebral arteries with no evidence of arterial dissection. A 33-year-old primipara was admitted to our hospital, presenting with two consecutive generalized tonic-clonic seizures lasting 2 and 5 min, respectively, on postpartum day 15. She had no history of epilepsy or migraine, did not have any risk factors for cardiovascular disease, had no familial history of epilepsy, and did not exhibit any symptoms or signs of any connective tissue disorder. On the third postpartum day, the patient was diagnosed with postpartum hypertension, but she * Jin San Lee [email protected] 1
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, South Korea
2
Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, South Korea
3
Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, South Korea
4
Department of Neurology, Seosan Jungang General Hospital, Seosan 32010, South Korea
was not on appropriate medications for the same. At the time of admission, the patient was drowsy and her blood pressure was 180/100 mmHg. A loading dose of intravenous sodium valproate (1200 mg) was promptly administered, and her initial blood laboratory test results, including markers of inflammation or infection, hypercoagulable panel, and serum glucose, were all within the reference interval. However, a computed tomography (CT) of the brain revealed low attenuation in the bilateral parieto-occipital regions. Her level of consciousness improved 30 min after the administration of antiepileptic drugs, but the patient complained of sudden-onset severe throbbing occipital headache. The headache was associated with vomiting and visual disturbance. Brain magnetic resonance imaging (MRI) revealed multiple hyperintense cortical and subcortical white matter lesions
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