title: Antepartum reversible cerebral vasoconstriction syndrome with pre-eclampsia and reversible posterior leukoencephalopathy.
abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headache and diffuse segmental constriction of the cerebral arteries that resolves spontaneously within a few months. Pregnancy is one of the precipitating factors of RCVS and most of the reported cases occurred in the post-partum period. We report a case of RCVS that occurred in a pregnant women with pre-eclampsia during her antepartum period. A 34-year-old woman in full-term pregnancy presented with a severe and acute headache. Magnetic resonance angiography (MRA) showed multiple segmental constrictions of the cerebral arteries. Magnetic resonance imaging revealed a high-intensity lesion in the left occipital lobe, consistent with reversible posterior leukoencephalopathy syndrome, on fluid attenuated inversion recovery sequences. The case was also complicated by severe pre-eclampsia and the patient underwent emergency cesarean section. Although her symptoms resolved rapidly, MRA revealed new lesions of arterial constriction 4 days after onset. The vasoconstriction completely resolved on MRA after 10 days and the patient was discharged without neurological sequelae.
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Matsushima
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Matsuzawa
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Wachi
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Izawa
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sakai
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwashita
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D002585:Cesarean Section; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D054038:Posterior Leukoencephalopathy Syndrome / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011247:Pregnancy
keywords: antepartum; headache; pre-eclampsia; reversible cerebral vasoconstriction; reversible posterior leukoencephalopathy