title: Postpartum cerebral angiopathy treated with intra-arterial nicardipine and intravenous immunoglobulin.
abstract: Postpartum cerebral angiopathy (PCA) is a rare vasoconstriction syndrome that can lead to severe disability and death. The pathophysiology of PCA is unknown. A case of a 39-year-old woman who developed PCA 3 days after twin delivery is reported. She presented with right hemiparesis, aphasia and lethargy. Imaging studies demonstrated severe segmental narrowing of multiple cerebral arteries comprising the anterior and posterior circulations. She continued to deteriorate despite induced hypertension, immunosuppression, intravenous magnesium and oral nimodipine. Intra-arterial administration of nicardipine on three consecutive occasions reversed the angiographic vasospasm and led to symptom resolution. Definite improvement occurred after a 5 day course of intravenous immunoglobulin (IVIg). The patient described in this report developed recalcitrant PCA-induced vasospasm which resolved with endovascular administration of nicardipine and immunotherapy with IVIg.
authors.affiliation: Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida 33156, USA. edgarsama@gmail.com
authors.forename: Edgar A
authors.initials: EA
authors.lastname: Samaniego
authors.forename: Guilherme
authors.initials: G
authors.lastname: Dabus
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Generoso
authors.forename: Francesca
authors.initials: F
authors.lastname: Tari-Capone
authors.forename: Karel
authors.initials: K
authors.lastname: Fuentes
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
mesh_terms: D000328:Adult; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007261:Infusions, Intra-Arterial; D009529:Nicardipine / Q000008:administration & dosage*; D049590:Postpartum Period / Q000187:drug effects* / Q000502:physiology; D011859:Radiography; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D016756:Immunoglobulins, Intravenous; D014665:Vasodilator Agents; D009529:Nicardipine