Intracerebral hemorrhage and postpartum cerebral vasculopathy.
BACKGROUND
Intracerebral hemorrhage (ICH) associated with pregnancy commonly occurs in the postpartum period in the setting of preeclampsia/eclampsia. We describe the clinical course of two patients with ICH due to postpartum cerebral vasculopathy in the absence of toxemia.


METHODS
We reviewed two cases with ICH and postpartum vasculopathy in our hospital (1996-2001) and compared them with seven similar case reports from the literature.


RESULTS
Mean age of all patients is 28.7+/-5.6 years (mean+/-S.D.). Toxemia of pregnancy was absent in all cases. ICHs were cortical in eight and putaminal in one patient. Erythrocyte sedimentation rate was elevated in two. Two cases rehemorrhaged during the same admission. No cerebral infarctions were reported. All patients had diffuse vasculopathy on conventional catheter angiography, with no clinical manifestations or laboratory data supportive of extracerebral or systemic vasculitis. Eight patients were treated with corticosteroids, two with additional cytotoxic agents and one with nimodipine alone. Improvement on follow-up cerebral angiography (catheter or MRA) and transcranial Doppler ultrasonography (TCD) was noted in eight cases. One did not have follow-up cerebral imaging but had an excellent clinical outcome. All cases had good to excellent functional recovery.


CONCLUSIONS
Postpartum ICH in the absence of toxemia may be associated with isolated cerebral vasculopathy. The clinical course and functional outcome is good to excellent. This entity appears to be distinct from cerebral vasculitis, which is usually associated with poor outcome.
Geocadin
Romergryko G
RG
Department of Neurology, Neurosciences Critical Care Division, Johns Hopkins Medical Institutions, Meyer 8-140, 600 N. Wolfe Street, Baltimore, MD 21287, USA. rgeocadi@jhmi.edu
Razumovsky
Alexander Y
AY
Wityk
Robert J
RJ
Bhardwaj
Anish
A
Ulatowski
John A
JA
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
D000305:Adrenal Cortex Hormones