Variable presentations of postpartum angiopathy.
OBJECTIVE
Postpartum angiopathy (PPA), a rare cause of stroke in the puerperium, is heralded by severe headaches within 1-2 weeks after delivery. Angiography demonstrates segmental vasoconstriction that often resolves spontaneously. PPA is generally regarded as benign. We aimed to define clinical presentations, radiological findings, and outcomes of patients with PPA.


METHODS
We retrospectively reviewed patients from 3 centers with acute neurological symptoms and angiography showing vasoconstriction in the postpartum period. Patients without neuroimaging and with diagnoses of cerebral venous sinus thrombosis and aneurysmal hemorrhage were excluded. Patient characteristics, clinical symptoms, neuroimaging findings, and clinical condition at hospital discharge were collected.


RESULTS
Eighteen patients (mean age, 31 years; range, 15-41) were identified. Median gestation was 38 weeks. Twelve (67%) had a history of prior uneventful pregnancy. Neurological symptoms began on median day 5 postpartum and included headache (n=16, 89%), focal deficit (n=9, 50%), visual disturbance (n=8, 44%), encephalopathy (n=6, 33%), and seizure (n=5, 28%), often in combination. Brain imaging was abnormal in most (n=13, 72%). The most common abnormalities were intracranial hemorrhage (n=7, 39%), vasogenic edema (n=6, 35%), and infarction (n=6, 35%). Clinical outcomes were markedly variable with full recovery seen in 9 (50%), death after a fulminant course in 4 (22%), and residual deficits in 5 (28%).


CONCLUSIONS
In contrast to prior reports, this group of patients with PPA had a higher proportion of nonbenign outcomes. Most patients who undergo neuroimaging have parenchymal abnormalities, which are most often stroke (hemorrhagic or ischemic) or reversible vasogenic edema.
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Jennifer E
JE
Fugate
Sebastián F
SF
Ameriso
Gustavo
G
Ortiz
Lucia V
LV
Schottlaender
Eelco F M
EF
Wijdicks
Kelly D
KD
Flemming
Alejandro A
AA
Rabinstein
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D009422:Nervous System Diseases / Q000209:etiology; D009460:Neurologic Examination; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D009626:Terminology as Topic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000502:physiology; D055815:Young Adult
D000305:Adrenal Cortex Hormones; D010975:Platelet Aggregation Inhibitors