Reversible cerebral vasoconstriction syndrome is certainly acknowledged increasingly as a complication

Reversible cerebral vasoconstriction syndrome is certainly acknowledged increasingly as a complication of the postpartum period. uncomplicated pregnancy and childbirth a healthy 40-year-old woman developed sudden severe and persisting headache. On day 1 postpartum she had been given a single dose of cabergoline (0.5 mg) for ablactation. Cerebral computed tomography (CCT) magnetic resonance imaging (MRI) electroencephalography (EEG) and lumbar puncture at a primary hospital showed no abnormalities. On day 7 postpartum she suffered a BRL-49653 generalized seizure with head trauma from a CRF (human, rat) Acetate fall. The CCT exhibited a cortical frontoparietal superfical subarachnoid hemorrhage (SAH) which was located beneath a skin BRL-49653 bruise; hence the SAH was considered traumatic. On admission to the stroke unit she complained of headache responded slowly to questions and had elevated blood pressure (200/100 mmHg) right peripheral visual deficits and extensor pyramidal indicators BRL-49653 on the right side. The BRL-49653 MRI revealed bilateral occipito-parietal vasogenic edema without evidence of sinus venous thrombosis (SVT) or arterial abnormalities (Physique 1). Transcranial Doppler ultrasound (TCD) showed normal circulation velocities with no evidence of vasospasm. Antihypertensive therapy with intravenous (i.v.) urapidil was initiated. However she complained further of double vision developed severe right-sided hemiparesis and became aphasic. Serial MRT scans showed segmental rapidly progressive arterial narrowing of all cerebral vessels (Physique 1). Hence nimodipin i.v. (1 mg/h) in combination with triple-H therapy (hypertension hypervolemia BRL-49653 hemodilution) was started. However multiple ischemic strokes and distributing of vasogenic edema emerged (Physique 1). Serum markers for connective tissue diseases systemic vasculitis urine catecholamines and investigation of cerebrospinal fluid biochemical screening for porphyrias as well as transthoracic echocardiography were unremarkable. Because of progressive generalized vasospasm i.v. methylprednisolon at a dosage of 1000 mg daily over five days was added with dose tapering to 80 mg orally until discharge. Under this treatment the patient stabilized and improved substantially. In line with this the MRI BRL-49653 showed quick regression of vasoconstriction and vasogenic edema and shrinking of DWI (diffusion weighted imaging) lesions (Physique 2). She was transferred to a rehabilitation center for physical therapy and speech therapy. At a follow-up visit three months later the aphasia experienced completely recovered and only a slight non-disabling paresis of the right leg persisted. Physique 1 A1-A4: magnetic resonance (MR) images on admission of patient.