Postpartum Cerebral Angiopathy

Diseases,

Synonyms:

Postpartum cerebral vasculopathy:

Diagnosis:

There are two forms:

  • Idiopathic postpartum angiopathy a.k.a. Call-Fleming postpartum angiopathy
  • Secondary postpartum cerebral angiopathy:
    • Due to bromocriptine (used for lactation suppression), ergot alkaloids (used for control postpartum hemorrhage), sympathomemimetics, nasal decongestants

Clinical features:

  • Headache, seizure, encephalopathy within 1 month of delivery
  • Normotensive (normal BP), no proteinuria

MRI:

  • In the idiopathic form: intraparenchymal hemorrhage (intracerebral hemorrhage).
  • T2 hyperintensities in white or grey matter, reversible
  • May have features of posterior reversible leukoencephalopathy syndrome PRESS.

Catheter Angiography:

  • Reversible multifocal stenosis
  • Beaded appearance of medium & small calibre arteries in the anterior circulation

Transcranial doppler ultrasound TCD:

  • Increased velocities= vasoconstriction. Reversible.

Pathology:

  • Non-specific: findings of ischemia.

 

Treatment:

  • Consider:
    • Nimodipine, other calcium channel blockers
    • Induced hypervolemia for vasospasm
    • Corticosteroids
  • Treat seizures if they occur
  • Angioplasty if refractory