Reversible cerebral vasoconstriction syndrome in puerperium: A prospective study.
OBJECTIVE
Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe "thunderclap" headache, with or without associated neurological symptoms and neuroimaging findings of reversible vasoconstriction of cerebral arteries. Puerperium is a recognized precipitant, but the incidence of puerperal RCVS is unknown. We conducted a prospective study to assess incidence, risk factors and clinical features of RCVS.


METHODS
Nine-hundred consecutive puerperae were prospectively enrolled within three days of delivery. Past medical history, basal demographic, anthropometric and biological variables were recorded. Transcranial Colour Coded Sonography (TCCS) was performed to assess early signs of vasospasm in brain vessels. A structured telephone interview was planned in all subjects one month postdelivery.


RESULTS
Thunderclap headache was recorded in 8 subjects (0.9%) on the first visit. At the one month follow-up interview 27 more patients reported having had at least one episode of thunderclap headache. In these 33 (3.8%) patients the course was spontaneously benign. One patient presented to the Emergency ward with throbbing thunderclap headache three weeks after delivery. Diagnostic work-up ended up in the diagnosis of RCVS, the outcome was favourable CONCLUSION: In normally coursing pregnancies and after uncomplicated delivery the risk of puerperal RCVS is negligible (0.1%). On the other way thunderclap headache may occur in a measurable proportion of (3.4%), although in the vast majority of cases (33/34=97%) it is of benign course. Transcranial Doppler sonography may be helpful to pick up those cases in whom further neuroradiological investigation is warranted.
Villa Gemma Hospital, Gardone Riviera, Italy. Electronic address: gpanzola@gmail.com.
Gian Paolo
GP
Anzola
Dept of Obstetrics and Gynaecology, Poliambulanza Hospital, Brescia, Italy.
Renato
R
Brighenti
Dept of Radiology, Poliambulanza Hospital, Brescia, Italy.
Milena
M
Cobelli
Dept of Neurology, Azienda Socio Sanitaria Territoriale, Cremona, Italy.
Alessia
A
Giossi
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Sara
S
Mazzucco
ULSS 22, Verona, Italy.
Silvia
S
Olivato
Dept of Neurology, Spedali Civili, University of Brescia, Brescia, Italy.
Elisa
E
Pari
Dept of Neurology, Poliambulanza Hospital, Brescia, Italy.
Maria Paola
MP
Piras
Dept of Neurology, Spedali Civili, University of Brescia, Brescia, Italy.
Alessandro
A
Padovani
Dept of Neurology, Spedali Civili, University of Brescia, Brescia, Italy.
Fabrizio
F
Rinaldi
Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital of Verona, Italy.
Giulia
G
Turri
D000293:Adolescent; D000328:Adult; D005260:Female; D051270:Headache Disorders, Primary / Q000000981:diagnostic imaging*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D049590:Postpartum Period; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging*; D055815:Young Adult
Cerebrovascular disease; Puerperium; Reversible cerebral vasoconstriction; Thunderclap headache