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post-partum angiopathy

Monday 7 November 2016

Post-Pregnancy Angiopathy; PCA ; postpartum cerebral angiopathy

Definition: Postpartum cerebral angiopathy (PPCA) is a rare form of reversible cerebral vasoconstriction syndrome.

Post-partum cerebral angiopathy (PCA) is a cerebrovascular disease that occurs during the postpartum period.

PPCA can rarely manifest as a life-threatening emergency for which neurosurgical intervention may be life-saving.

Postpartum angiopathy (PPA) is a rare cause of stroke in the puerperium. It is heralded by severe headaches within 1-2 weeks after delivery.

Angiography demonstrates segmental vasoconstriction that often resolves spontaneously.

PPA is generally regarded as benign. but, patients with PPA had a higher proportion of nonbenign outcomes.

Most patients who undergo neuroimaging have parenchymal abnormalities, which are most often stroke (hemorrhagic or ischemic) or reversible vasogenic edema.

Synopsis

- non-aneurysmal subarachnoid hemorrhage (24262456)
- intracerebral hemorrhage (ICH)
- intraventricular hemorrhage
- interval development of neurological deficits (24262456)
- reversible multifocal vasoconstriction of the cerebral arteries

- cerebral angiography : multifocal, segmental narrowing of the cerebral arteries and non-aneurysmal subarachnoid hemorrhage.

- focal neurological deficits

Treatment

- calcium-channel blockers as nicardipine (24262456, 22345147)
- intravenous immunoglobulin (22345147)

- monitoring by daily transcranial Doppler ultrasound

Open references

- Postpartum cerebral angiopathy presenting with non-aneurysmal subarachnoid hemorrhage and interval development of neurological deficits: a case report and review of literature. Yang L, Bai HX, Zhao X, Xiao Y, Tan L. Neurol India. 2013 Sep-Oct;61(5):517-22. doi : 10.4103/0028-3886.121933 PMID: 24262456 Free

- Variable presentations of postpartum angiopathy. Fugate JE, Ameriso SF, Ortiz G, Schottlaender LV, Wijdicks EF, Flemming KD, Rabinstein AA. Stroke. 2012 Mar;43(3):670-6. doi : 10.1161/STROKEAHA.111.639575 PMID: 22223244 Free