title: Unique case of postpartum cerebral angiopathy requiring surgical intervention: case report and review of literature.
abstract: Postpartum cerebral angiopathy (PPCA) is a rare form of reversible cerebral vasoconstriction syndrome. A 39-year-old female presented with a 5×6 cm left frontal intracerebral hemorrhage (ICH) and following an emergent neurosurgical evacuation of ICH, she developed a contralateral ICH and intraventricular hemorrhage. Her postoperative course was highlighted by the finding of diffuse bilateral segmental vasospasm on angiography and trans-cranial Doppler, left anterior cerebral artery region infarct and intractable elevated intracranial pressure (ICP). Medical management including osmotic therapy, nimodipine, corticosteroids, and phenytoin was unable to control ICP. Intractable elevated ICP led to evacuation of the right-sided ICH. After 3.5 years, the patient appears to be cognitively intact but continues to have right lower extremity weakness and is wheelchair-bound. Our case suggests that PPCA can rarely manifest as a life-threatening emergency for which neurosurgical intervention may be life-saving.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana 71103, USA.
authors.forename: Jai Deep
authors.initials: JD
authors.lastname: Thakur
authors.forename: Prashant
authors.initials: P
authors.lastname: Chittiboina
authors.forename: Imad Saeed
authors.initials: IS
authors.lastname: Khan
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D049590:Postpartum Period; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy