title: Intra-arterial nicardipine for the treatment of cerebral vasospasm in postpartum cerebral angiopathy: a case study and review of literature.
abstract: BACKGROUND
  Postpartum cerebral angiopathy is one of the many neurological complications seen during pregnancy and the postpartum period. Management of these patients consists of optimal blood pressure control, and general supportive critical care. We present a case of diffuse cerebral vasospasm, which improved with intra-arterial nicardipine. This brief report addresses the utility of interventional management in cases of postpartum cerebral angiopathy.
  
  
  METHODS
  A 28-year-old female presented 1 week after cesarean delivery with altered mental status, endotracheal intubation for airway protection, thrombocytopenia, and hypofibrinogenemia. Cerebral angiogram revealed anterior and posterior circulation vasospasm, which responded to repeated selective intra-arterial injections of nicardipine. This treatment coupled with optimal blood pressure control resulted in complete recovery.
  
  
  CONCLUSIONS
  Our case report highlights the importance of cerebral angiography for the diagnosis and treatment of patients with postpartum cerebral angiopathy. Although nicardipine is used in patients with aneurysmal subarachnoid hemorrhage for the treatment of cerebral vasospasm, this agent has the potential to be used in patients with cerebral vasospasm due to other etiologies.
  
  
  CONCLUSIONS
  Intra-arterial nicardipine is one of the therapeutic measures available to physicians in the management of patients with cerebral vasospasm. In patients with postpartum cerebral angiopathy, early cerebral angiography should be considered to quantify and treat cerebral vasospasm with either angioplasty or selective intra-arterial injections of nicardipine.
authors.affiliation: Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA. alele@kumc.edu
authors.forename: Abhijit
authors.initials: A
authors.lastname: Lele
authors.forename: Timothy
authors.initials: T
authors.lastname: Lyon
authors.forename: Ania
authors.initials: A
authors.lastname: Pollack
authors.forename: Kathrin
authors.initials: K
authors.lastname: Husmann
authors.forename: Alan
authors.initials: A
authors.lastname: Reeves
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D009529:Nicardipine / Q000008:administration & dosage*; D049590:Postpartum Period; D011247:Pregnancy; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial; D014665:Vasodilator Agents / Q000008:administration & dosage*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology
chemical_list: D014665:Vasodilator Agents; D009529:Nicardipine