Postpartum internal carotid and vertebral arterial dissections.
OBJECTIVE
Headache and neck pain are common postpartum symptoms. However, these symptoms can rarely be associated with internal carotid artery and vertebral artery dissections. We aimed to review five cases of postpartum cervical artery dissection and to review the clinical course of previously reported cases.


METHODS
Patients with postpartum dissections diagnosed at our institution since 2005 were identified through a database maintained by the senior author, and their clinical data were reviewed. Additionally, a literature search for previously reported cases was performed, and the clinical data in those reports were reviewed.


RESULTS
Five patients presented with cervical artery dissections within 6 weeks postpartum. Four patients had delivered vaginally and one delivered by emergent cesarean. Headache and neck pain were the primary presenting symptoms of all five patients. Four patients demonstrated neurologic symptoms, and one had development of stroke. Two patients had single internal carotid artery dissections, one patient had bilateral dissections of the vertebral artery, and two patients had dissections in the internal carotid artery and vertebral artery. All patients were treated with either anticoagulation therapy or antiplatelet therapy. Two patients required endovascular stenting. Four of five patients returned to neurologic baseline after treatment. A literature search yielded 27 previously reported cases, with similar clinical characteristics of older reproductive age, presentation days to weeks from delivery, and recovery to neurologic baseline in the majority of patients.


CONCLUSIONS
Postpartum cervical dissections are rare occurrences that require prompt diagnosis to prevent long-term neurologic deficits. Individualized management strategies include medical treatment (anticoagulation therapy, antiplatelet therapy, or anticoagulation and antiplatelet therapy) and endovascular recanalization.
Cerebrovascular and Endovascular Division, Department of Neurosurgery, and the Department of Obstetrics and Gynecology, Tufts Medical Center and Tufts University, Boston, Massachusetts.
Jeannie C
JC
Kelly
Mina G
MG
Safain
Marie
M
Roguski
Andrea G
AG
Edlow
Adel M
AM
Malek
D000328:Adult; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D017359:HELLP Syndrome; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis*; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin