title: Postpartum vertebral artery dissection with posterior reversible encephalopathy syndrome.
abstract: We diagnosed postpartum eclampsia with posterior reversible encephalopathy syndrome (PRES) in a 35-year-old woman who began experiencing headaches after delivery. Cervical MR angiography (MRA) suggested concomitant vertebral artery (VA) dissection. Antiplatelet therapy was not indicated. Each episode resolved spontaneously. The patient subsequently developed sudden onset of thunderclap headache. She experienced a tonicoclonic seizure in the outpatient clinic. On the basis of clinical course and MRI, we diagnosed postpartum eclampsia with PRES. Antiplatelet therapy was not indicated, as there were no signs of stroke. Antiepileptic and antihypertensive medicines were used for a short term to control seizure and blood pressure. Subsequent MRI 17 days after discharge showed resolution of the abnormal signals, but the intramural heme signals became apparent on the dissecting segment of VA. Subsequent MRI after 3 months indicated resolution of arterial dissection. To the best of our knowledge, this represents the third report of postpartum cervicocephalic artery dissection with PRES in the literature.
authors.affiliation: Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hiraoka
authors.affiliation: Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kanazawa
authors.affiliation: Department of General Internal Medicine, Kobe University Hospital, Kobe, Hyogo, Japan.
authors.forename: Hozuka
authors.initials: H
authors.lastname: Akita
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D005260:Female; D051270:Headache Disorders, Primary / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008278:Magnesium Sulfate / Q000008:administration & dosage; D018810:Magnetic Resonance Angiography; D009529:Nicardipine / Q000008:administration & dosage*; D010672:Phenytoin / Q000008:administration & dosage*; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D049590:Postpartum Period; D012640:Seizures / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000503:physiopathology
chemical_list: D000927:Anticonvulsants; D000959:Antihypertensive Agents; D010672:Phenytoin; D008278:Magnesium Sulfate; D009529:Nicardipine