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angiopathy cerebral postpartum

Dániel Bereczki, Norbert Szegedi, Zoltán Szakács, István Gubucz, Zsolt May
An estimated 25-40% of ischemic strokes are classified as cryptogenic, which means the cause of the cerebral infarction remains unidentified. One of the potential pathomechanisms - especially among young patients with no cardiovascular risk factors - is paradoxical embolism through a patent foramen ovale. Pregnancy, cesarean delivery and the postpartum period are associated with an increased risk of cerebrovascular events. Factors that may contribute to ischemic strokes during gestation and puerperium include classic cardiovascular risk factors, changes in hemostaseology/hemodynamics, and pregnancy-specific disorders such as pre-eclampsia, eclampsia, postpartum cerebral angiopathy or peripartum cardiomyopathy...
2016: Neurologia i Neurochirurgia Polska
Lotfi Hacein-Bey, Panayiotis N Varelas, John L Ulmer, Leighton P Mark, Kesav Raghavan, James M Provenzale
OBJECTIVE: The purpose of this article is to review the unique physiologic changes that characterize pregnancy and the puerperium, some that substantially affect the cerebrovascular system. Conditions that can cause neurologic deterioration and share features with preeclampsia-eclampsia include postpartum angiopathy, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and amniotic fluid embolism. Other conditions not specific to this patient group include cerebral venous thrombosis, cervicocephalic arterial dissection, ischemic stroke, and hemorrhagic stroke, which can pose specific diagnostic and therapeutic challenges...
January 2016: AJR. American Journal of Roentgenology
N Bernard, H Jantzem, M Becker, C Pecriaux, A Bénard-Laribière, J L Montastruc, J Descotes, T Vial
OBJECTIVE: To assess the nature and conditions of the occurrence of adverse drug reactions (ADRs) of bromocriptine, which is used to inhibit lactation. DESIGN: Observational study. SETTING: Cases from the French pharmacovigilance database and the marketing authorisation holders. SAMPLE: Serious ADRs reported between 1994 and 2010 in association with bromocriptine used for lactation inhibition in France. METHODS: Each case was checked to confirm the bromocriptine indication, the seriousness of the ADR, the modalities of bromocriptine use, and to identify possible associated predisposing factors...
August 2015: BJOG: An International Journal of Obstetrics and Gynaecology
Ali Razmara, Khamid Bakhadirov, Ayush Batra, Steven K Feske
Cerebrovascular complications of pregnancy, though uncommon, threaten women with severe morbidity or death, and they are the main causes of major long-term disability associated with pregnancy. In this review, we discuss the epidemiology, pathophysiology, presentation and diagnosis, and management and outcomes of ischemic and hemorrhagic stroke and cerebral venous thrombosis. We also discuss the posterior reversible encephalopathy syndrome, the reversible cerebral vasoconstriction syndrome including postpartum cerebral angiopathy, and their relationship as overlapping manifestations of pre-eclampsia-eclampsia...
2014: Current Cardiology Reports
Jennifer A Frontera, Wamda Ahmed
Neurocritical care complications of pregnancy and puerperum such as preeclampsia/eclampsia, hemolysis, elevated liver enzymes, low platelets syndrome, thrombotic thrombocytopenic purpura, seizures, ischemic and hemorrhagic stroke, postpartum angiopathy, cerebral sinus thrombosis, amniotic fluid emboli, choriocarcinoma, and acute fatty liver of pregnancy are rare but can be devastating. These conditions can present a challenge to physicians because pregnancy is a unique physiologic state, most therapeutic options available in the intensive care unit were not studied in pregnant patients, and in many situations, physicians need to deliver care to both the mother and the fetus, simultaneously...
December 2014: Journal of Critical Care
Li Yang, Harrison X Bai, Xin Zhao, Yanqiao Xiao, Liming Tan
Postpartum cerebral angiopathy (PCA) is a cerebrovascular disease that occurs during the postpartum period. It is characterized by reversible multifocal vasoconstriction of the cerebral arteries. We report a patient with PCA proven by cerebral angiography that revealed multifocal, segmental narrowing of the cerebral arteries and non-aneurysmal subarachnoid hemorrhage. The patient suddenly deteriorated with focal neurological deficits on the 5 th day of hospitalization. She was treated with calcium-channel blockers and monitored with daily transcranial Doppler ultrasound...
September 2013: Neurology India
Małgorzata Wiszniewska, Amelia Bytowska
Postpartum cerebral angiopathy is a relatively rare condition. It can cause either ischemic or hemorrhagic stroke, or both, and usually occurs within the first week following non-complicated pregnancy and natural delivery. Although its pathophysiology is unclear, the cause of the condition is believed to be prolonged reversible vasospasm. We present an unusual case of a 37-year-old woman who developed right hemiparesis with aphasia on day 8 of natural delivery complicated by pulmonary embolism. Steroids, heparin, and calcium channel blockers were successfully instituted and the patient was discharged from the hospital on day 50...
June 2013: Acta Clinica Croatica
A M Mortimer, M D Bradley, M Likeman, N G Stoodley, S A Renowden
Several diverse neurological conditions may be seen during pregnancy and the post partum period. These usually require neuroimaging for definitive diagnosis and range from a predisposition to neurovascular abnormalities, such as acute ischaemic stroke and cerebral venous sinus thrombosis, through to more specific pregnancy-related conditions, such as eclampsia/posterior reversible leukoencephalopathy and post-partum angiopathy. Additionally, the pregnant patient is predisposed to pituitary disease. It is necessary that the radiologist has an awareness of these conditions to allow swift specific diagnoses or suggest the most appropriate diagnosis when imaging findings are non-specific...
May 2013: Clinical Radiology
Yoshinobu Takahashi, Naoya Hashimoto, Hiroki Tokoroyama, Shigeru Yamauchi, Matsuyoshi Nakasato, Kimito Kondo, Kazumi Nitta, Wataru Ide, Ikuo Hashimoto, Hajime Kamada
Reversible lesions on magnetic resonance imaging that transiently restrict diffusion in the splenium of the corpus callosum (SCC) without any other accompanying lesions have been reported in various clinical conditions. We offer the first report of postpartum cerebral angiopathy with reversible SCC lesions.
May 2014: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Robin Lemmens, Stephanie Smet, Guido Wilms, Philippe Demaerel, Vincent Thijs
Postpartum angiopathy as clinical presentation of reversible cerebral vasoconstriction syndrome remains an intriguing phenomenon. The diagnosis needs to be considered in women presenting with thunderclap headache with or without associated neurological deficits. Here, we present a patient with thunderclap headache with initial normal laboratory and cerebral imaging findings, including intracranial angiography. Her condition worsened over several days and magnetic resonance imaging revealed changes initially compatible with posterior reversible encephalopathy syndrome, sequentially ischemic stroke and narrowing of the intracranial arteries...
June 2012: Acta Neurologica Belgica
Edgar A Samaniego, Guilherme Dabus, Gillian M Generoso, Francesca Tari-Capone, Karel Fuentes, Italo Linfante
Postpartum cerebral angiopathy (PCA) is a rare vasoconstriction syndrome that can lead to severe disability and death. The pathophysiology of PCA is unknown. A case of a 39-year-old woman who developed PCA 3 days after twin delivery is reported. She presented with right hemiparesis, aphasia and lethargy. Imaging studies demonstrated severe segmental narrowing of multiple cerebral arteries comprising the anterior and posterior circulations. She continued to deteriorate despite induced hypertension, immunosuppression, intravenous magnesium and oral nimodipine...
May 2013: Journal of Neurointerventional Surgery
Jeffrey S Alvis, Richard J Hicks
Neurologic complications and conditions associated with pregnancy are rare. Frequently, presenting symptoms of neurologic conditions are nonspecific and can overlap with normal symptoms of pregnancy. As a result, clinical assessment can be insufficient to differentiate symptoms of a normal pregnancy from a neurologic disorder. It is imperative that the radiologist have a basic familiarity with the most common neurologic conditions encountered in pregnancy. The most commonly imaged acute and nonemergent disorders will be described, including eclampsia, cerebrovascular disease including cerebral venous thrombosis, postpartum cerebral angiopathy, multiple sclerosis, tumors, Bell palsy, Guillain-Barré syndrome, and pituitary disorders...
February 2012: Seminars in Ultrasound, CT, and MR
Jai Deep Thakur, Prashant Chittiboina, Imad Saeed Khan, Anil Nanda
Postpartum cerebral angiopathy (PPCA) is a rare form of reversible cerebral vasoconstriction syndrome. A 39-year-old female presented with a 5×6 cm left frontal intracerebral hemorrhage (ICH) and following an emergent neurosurgical evacuation of ICH, she developed a contralateral ICH and intraventricular hemorrhage. Her postoperative course was highlighted by the finding of diffuse bilateral segmental vasospasm on angiography and trans-cranial Doppler, left anterior cerebral artery region infarct and intractable elevated intracranial pressure (ICP)...
November 2011: Neurology India
Jennifer E Fugate, Sebastián F Ameriso, Gustavo Ortiz, Lucia V Schottlaender, Eelco F M Wijdicks, Kelly D Flemming, Alejandro A Rabinstein
BACKGROUND AND PURPOSE: Postpartum angiopathy (PPA), a rare cause of stroke in the puerperium, 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. We aimed to define clinical presentations, radiological findings, and outcomes of patients with PPA. METHODS: We retrospectively reviewed patients from 3 centers with acute neurological symptoms and angiography showing vasoconstriction in the postpartum period...
March 2012: Stroke; a Journal of Cerebral Circulation
Y Ruzic, D Tran-Van, A Omarjee, M Boukerrou, A Winer
We report the case of a 29-year-old female who had developed a postpartum cerebral angiopathy (PCA) complicated by an intracerebral haematoma and convulsions, after a postpartum haemorrhage with sulprostone and norepinephrine infusion. PCA is an under diagnosed neurovascular pathology, responsible of reversible and non-specific symptoms. However, it can be complicated by haemorrhagic or ischemic stroke with vital or functional risks. As PCA is favored by vasoactive treatments, their administration in peripartum period, when it is imperative, should be strictly controlled...
January 2012: Annales Françaises D'anesthèsie et de Rèanimation
Jan Rémi, Thomas Pfefferkorn, Gunther Fesl, Nina Rogenhofer, Andreas Straube, Matthias Klein
Postpartum cerebral angiopathy (PCA) is a cerebral vasoconstriction syndrome developing shortly after delivery, without signs of preceding eclampsia. The risk for recurrence of PCA is unknown. Here, we report on a closely monitored, uneventful pregnancy of a woman with a previous severe episode of PCA. In summary, this case report demonstrates that PCA does not necessarily recur in following pregnancies, even after previous severe episodes.
September 2011: Case Reports in Neurology
Abhijit Lele, Timothy Lyon, Ania Pollack, Kathrin Husmann, Alan Reeves
INTRODUCTION: Postpartum cerebral angiopathy is one of the many neurological complications seen during pregnancy and the postpartum period. Management of these patients consists of optimal blood pressure control, and general supportive critical care. We present a case of diffuse cerebral vasospasm, which improved with intra-arterial nicardipine. This brief report addresses the utility of interventional management in cases of postpartum cerebral angiopathy. CASE REPORT: A 28-year-old female presented 1 week after cesarean delivery with altered mental status, endotracheal intubation for airway protection, thrombocytopenia, and hypofibrinogenemia...
October 2011: International Journal of Neuroscience
Seo-Young Lee, Seung Hun Sheen, Seung Hwan Lee, Sam Soo Kim, Chung Hyo Kim, Kil Soo Yie, Sung Hun Kim
Parturition increases the risk of strokes of various types, including postpartum cerebral angiopathy (PCA), which is characterized by reversible multifocal vasoconstriction of the cerebral arteries. We describe an unusual presentation of PCA associated with postpartum non-aneurysmal subarachnoid hemorrhage (SAH). A 31-year-old multiparous woman complained of sudden headache 3 hours after an uncomplicated vaginal delivery. She had no history of pregnancy-induced hypertension. SAH was found over the bilateral frontoparietal convexities with multifocal vasculopathy...
September 2011: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Ligia Lima Bittencourt, Antonio Carlos Martins Maia, Antônio José da Rocha
No abstract text is available yet for this article.
2011: Arquivos de Neuro-psiquiatria
Elisabetta Del Zotto, Alessia Giossi, Irene Volonghi, Paolo Costa, Alessandro Padovani, Alessandro Pezzini
Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke...
2011: Stroke Research and Treatment
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