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Case report
Postpartum cerebral angiopathy treated with intra-arterial nicardipine and intravenous immunoglobulin
  1. Edgar A Samaniego1,
  2. Guilherme Dabus1,
  3. Gillian M Generoso2,
  4. Francesca Tari-Capone3,
  5. Karel Fuentes4,
  6. Italo Linfante1
  1. 1Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  2. 2Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
  3. 3Department of Neuroscience, Mental Health and Sensory Organs, University of Rome La Sapienza, Rome, Italy
  4. 4Neurocritical Care, Baptist Hospital, Miami, Florida, USA
  1. Correspondence to Dr E A Samaniego, Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, 7355 SW 89th St, APT 627 N, Miami, FL 33156, USA; edgarsama{at}gmail.com

Abstract

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. Intra-arterial administration of nicardipine on three consecutive occasions reversed the angiographic vasospasm and led to symptom resolution. Definite improvement occurred after a 5 day course of intravenous immunoglobulin (IVIg). The patient described in this report developed recalcitrant PCA-induced vasospasm which resolved with endovascular administration of nicardipine and immunotherapy with IVIg.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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