Reversible Cerebral Vasoconstriction Syndrome in Postpartum Patient With Spontaneous Intracranial Hypotension: A Case Report

Abstract BackgroundReversible cerebral vasoconstriction syndrome (RCVS) is a rare secondary headache disorder. It may have possibly fatal consequences but its pathophysiological basis is still debated. Herein, we presented a rare case of postpartum patient with spontaneous intracranial hypotension (SIH) suffered RCVS. Case presentationA 29-year-old nulliparous female underwent SIH as a result of painless labor and the clinical symptom of postural headache was relieved with a conservative treatment. Two days later, she suffered new-onset thunderclap headache with cortical blindness and generalized seizure; meanwhile, arterial pressure was higher than the normal value. MRI scan found FLAIR hyperintensities in the right cerebellum, left caudate nucleus and bilateral frontotemporal parietal occipital lobes with predominant vasogenic edema. Simultaneously, MR angiography revealed segmental vasoconstriction involving arteries of anterior and posterior cerebral circulations. Taken together, these findings were in accordance with the diagnostic criteria of RCVS and the abnormal MRI hypersignals were mostly consistent with posterior reversible encephalopathy syndrome (PRES). On day 10, she recovered completely and previous abnormal signals disappeared markedly with the treatment of bed rest, high-dose fluids, non-steroidal drug, calcium channel blocker and antiepileptic drug.ConclusionsRCVS can occur in postpartum patients with SIH, and PRES may also encounter in these cases. A heightened awareness of the disease accompanied by typical clinical and imaging features are associated with an early diagnosis and a better prognosis.