Abstract
Postpartum anjiopati (PPA) doğumdan sonraki ilk 1 ay içerisinde meydana gelen büyük, orta ve küçük arter geçici vasospazmına bağlı gelişen klinik tablodur. Genellikle ani başlayan, saniyeler içerisinde şiddeti artan özellikte başağrısı, nöbet ve/veya fokal nörolojik defisit ile karakterize olur. Biz de literatürde nadir görülen bir postpartum anjiopati vakasını sunmayı planladık. Preeklampsi tanılı, sezaryanla 29. haftada ilk doğumu gerçekleştirilen 26 yaş hastanın operasyondan 2 gün sonra başağrısı, görme bulanıklığı ve sol bacakta kuvvet kaybı şikayeti gelişmiş. Nörolojik muayenede sol alt extremite proksimal kas kuvveti 4/5, ayak plantar flexiyonu ve dorsal fleksiyon kas kuvveti 1/5 tespit edildi. Kranial manyetik rezonans (MR) görüntülemede sağ paryetooksipital kortekste, sağ frontal beyaz cevherde, sol frontoparyetel parasagittal korteks ve korpus kallosumda difüzyon kısıtlanması gösteren dağınık ve değişken boyutta odaklar izlendi. 15 gün sonra çekilen kontrol kranial MR-MR anjiografi görüntülemesinde 15 gün önce kranial MR’da izlenen her iki serebral hemisferde difüzyon kısıtlanması ile karakterize multifokal odaklarda sitotoksik paternin yerini vazojenik ödem paternine bıraktığı izlendi. Ayrıca arteryel kontrast dolumunun 15 gün önceki MR’a göre bariz artış gösterdiği izlendi. Bu durum multifokal iskeminin geçici vazospazma bağlı olduğunu düşündürdü ve hastaya postpartum anjiopati tanısı konuldu. Çıkış nörolojik muayenesi tamamen doğal hale gelmişti. PPA nadir görülen ve agresif seyredebilen bir antitedir. Genellikle kendini sınırlayan ve sekelsiz düzelen bir kliniğinin olmasına rağmen kalıcı hasar gelişen ve ölümle sonuçlanan vakalar da bulunmaktadır. Hasta sonuçlarını iyileştirmek için altta yatan patofizyolojik mekanizmaların ve tedavi protokollerinin net bir şekilde aydınlatılmasına ihtiyaç vardır.
Keywords
References
- 1. Singhal AB, Bernstein RA. Postpartum angiopathy and other cerebral vasoconstriction syndromes. Neurocritical Care. 2005;3(1):91–97.
- 2. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics 2018 Update: A Report From the American Heart Association. Circulation. 2018;20;137(12):1–426.
- 3. Swartz RH, Cayley ML, Foley N, et al. The incidence of pregnancy-related stroke: A systematic review and meta-analysis. International Journal of Stroke. 2017;12(7):687–97.
- 4. Cantu-Brito C, Arauz A, Aburto Y, et al. Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women. Eur J Neurol [Internet]. 2011;18(6):819–25.
- 5. Anzola GP, Brighenti R, Cobelli M, et al. Reversible cerebral vasoconstriction syndrome in puerperium: A prospective study. Journal of the Neurological Sciences. 2017;15(375):130–6.
- 6. Singhal AB, Koroshetz WJ, Caplan LR. Cerebral vasoconstriction syndromes. In: Bogousslavsky J ed. Uncommon Causes of Stroke. Cambridge: Cambridge University, 2001;114-23.
- 7. Song TJ, Lee KH, Li H, et al. Reversible cerebral vasoconstriction syndrome: a comprehensive systematic review. European Review for Medical and Pharmacological Sciences. 2021;25(9):3519-29.
- 8. Calabrese LH, Dodick DW, Schwedt TJ, et al. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146(1):34-44.
- 9. Bogousslavsky, J, Despland, PA, Regli F, et al. Postpartum cerebral angiopathy. Reversible vasoconstriction assessed by transcranial Doppler ultrasounds. European Neurology. 1989;29(2):102–5.
- 10. Chik Y, Hoesch RE, Lazaridis C, et al. A case of postpartum cerebral angiopathy with subarachnoid hemorrhage. Nat Rev Neurol. 2009;5(9):512-6.
- 11. Fugate JE, Wijdicks EF, Parisi JE, et al. Fulminant postpartum cerebral vasoconstriction syndrome. Arch Neurol. 2012;69(1):111-7.
- 12. Geraghty JJ, Hoch DB, Robert ME, et al. Fatal puerperal cerebral vasospasm and stroke in a young woman. Neurology. 1991;41(7):1145-7.
- 13. Calado S, Vale-Santos J, Lima C, et al. Postpartum cerebral angiopathy: Vasospasm, vasculitis or both? Cerebrovasc Dis. 2004;18(4):340-1.
- 14. Steegers EAP, Von Dadelszen P, Duvekot JJ, Pijnenborg R. Preeclampsia. Lancet. 2010;376(9741):631–44.
- 15. Williams TL, Lukovits TG, Harris BT, et al. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet. 2007;275(1):67-77.
- 16. Ursell MR, Marras CL, Farb R, et al. Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: Implications for management. Stroke. 1998;29(9):1995-8.
- 17. Hull AD, Long DM, Longo LD, et al. Pregnancy-induced changes in ovine cerebral arteries. Am J Physiol.1992;262(1):137-43.
- 18. Williams TL, Lukovits TG, Harris BT, et al. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet. 2007;275(1):67-77.
- 19. Camargo EC, Feske SK, Singhal AB. Stroke in pregnancy: an update. Neurol. Clin. 2019;37(1):131–48.
Abstract
Postpartum angiopathy (PPA) is a clinical picture that develops due to transient vasospasm of large, medium, and small arteries within the first month after birth. It is usually characterized by sudden onset, increasing severity within seconds, mainly headache, seizure, and/or focal neurological deficit. We also planned to present a rare case of postpartum angiopathy in the literature. A 26-year-old patient diagnosed with preeclampsia, who gave birth for the first time at week 29 by cesarean section, developed headache, blurred vision, and loss of strength in the left leg two days after the operation. In the neurological examination, the left lower extremity proximal muscle strength was 4/5, and the foot plantar flexion and dorsal flexion muscle strength was 1/5. Cranial magnetic resonance imaging (MRI) revealed diffuse and variable-sized foci with diffusion restriction in the right parietooccipital cortex, right frontal white matter, left frontoparietal parasagittal cortex, and corpus callosum. In control cranial MR-MR angiography taken 15 days later, it was observed that the cytotoxic pattern was replaced by the vasogenic edema pattern in multifocal foci characterized by diffusion restriction in both cerebral hemispheres observed on cranial MR 15 days ago. In addition, it was observed that the arterial contrast filling showed a significant increase compared to the MRI 15 days ago. This suggested that multifocal ischemia was due to transient vasospasm, and the patient was diagnosed with postpartum angiopathy. The discharge neurological examination had become entirely natural. PPA is a rare and aggressive entity. Although it produces a self-limiting and resolving clinic without sequelae, some cases develop permanent damage and result in death. A straightforward elucidation of the underlying pathophysiological mechanisms and treatment protocols is needed to improve patient outcomes.
Keywords
References
- 1. Singhal AB, Bernstein RA. Postpartum angiopathy and other cerebral vasoconstriction syndromes. Neurocritical Care. 2005;3(1):91–97.
- 2. Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics 2018 Update: A Report From the American Heart Association. Circulation. 2018;20;137(12):1–426.
- 3. Swartz RH, Cayley ML, Foley N, et al. The incidence of pregnancy-related stroke: A systematic review and meta-analysis. International Journal of Stroke. 2017;12(7):687–97.
- 4. Cantu-Brito C, Arauz A, Aburto Y, et al. Cerebrovascular complications during pregnancy and postpartum: clinical and prognosis observations in 240 Hispanic women. Eur J Neurol [Internet]. 2011;18(6):819–25.
- 5. Anzola GP, Brighenti R, Cobelli M, et al. Reversible cerebral vasoconstriction syndrome in puerperium: A prospective study. Journal of the Neurological Sciences. 2017;15(375):130–6.
- 6. Singhal AB, Koroshetz WJ, Caplan LR. Cerebral vasoconstriction syndromes. In: Bogousslavsky J ed. Uncommon Causes of Stroke. Cambridge: Cambridge University, 2001;114-23.
- 7. Song TJ, Lee KH, Li H, et al. Reversible cerebral vasoconstriction syndrome: a comprehensive systematic review. European Review for Medical and Pharmacological Sciences. 2021;25(9):3519-29.
- 8. Calabrese LH, Dodick DW, Schwedt TJ, et al. Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med. 2007;146(1):34-44.
- 9. Bogousslavsky, J, Despland, PA, Regli F, et al. Postpartum cerebral angiopathy. Reversible vasoconstriction assessed by transcranial Doppler ultrasounds. European Neurology. 1989;29(2):102–5.
- 10. Chik Y, Hoesch RE, Lazaridis C, et al. A case of postpartum cerebral angiopathy with subarachnoid hemorrhage. Nat Rev Neurol. 2009;5(9):512-6.
- 11. Fugate JE, Wijdicks EF, Parisi JE, et al. Fulminant postpartum cerebral vasoconstriction syndrome. Arch Neurol. 2012;69(1):111-7.
- 12. Geraghty JJ, Hoch DB, Robert ME, et al. Fatal puerperal cerebral vasospasm and stroke in a young woman. Neurology. 1991;41(7):1145-7.
- 13. Calado S, Vale-Santos J, Lima C, et al. Postpartum cerebral angiopathy: Vasospasm, vasculitis or both? Cerebrovasc Dis. 2004;18(4):340-1.
- 14. Steegers EAP, Von Dadelszen P, Duvekot JJ, Pijnenborg R. Preeclampsia. Lancet. 2010;376(9741):631–44.
- 15. Williams TL, Lukovits TG, Harris BT, et al. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet. 2007;275(1):67-77.
- 16. Ursell MR, Marras CL, Farb R, et al. Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: Implications for management. Stroke. 1998;29(9):1995-8.
- 17. Hull AD, Long DM, Longo LD, et al. Pregnancy-induced changes in ovine cerebral arteries. Am J Physiol.1992;262(1):137-43.
- 18. Williams TL, Lukovits TG, Harris BT, et al. A fatal case of postpartum cerebral angiopathy with literature review. Arch Gynecol Obstet. 2007;275(1):67-77.
- 19. Camargo EC, Feske SK, Singhal AB. Stroke in pregnancy: an update. Neurol. Clin. 2019;37(1):131–48.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Publication Date | April 28, 2025 |
| Acceptance Date | July 8, 2023 |
| Published in Issue | Year 2025 Volume: 26 Issue: 2 |
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