Reversible cerebral vasoconstriction syndrome in the postpartum period: A case report and review of the literature

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare phenomenon that can present in the postpartum period. We show the experience of a 35-year-old patient who presented with headache after an uncomplicated pregnancy and vaginal delivery. She was initially diagnosed with pre-eclampsia, and subsequently with RCVS following discovery of multifocal vascular narrowing on magnetic resonance arteriography (MRA). Verapamil was initiated, and at 1 month there was improvement intracranially, but cervical vertebral arterial narrowing, likely dissection, was discovered. Verapamil was continued and aspirin was initiated. Follow-up imaging 5 months postpartum demonstrated near-complete resolution of previously noted abnormalities, which remained stable at reimaging at 10 months postpartum. In conclusion, the symptoms of RCVS can mimic or coexist with pre-eclampsia. Early intracranial imaging such as MRA can permit timely diagnosis and facilitate appropriate management and follow-up.

Automated summary

We present a case of a 35-year-old postpartum patient who presented with headache and was initially diagnosed with pre-eclampsia, but was later diagnosed with reversible cerebral vasoconstriction syndrome (RCVS) based on imaging findings. Verapamil was initiated and there was improvement in intracranial abnormalities, but cervical vertebral arterial narrowing, possibly due to dissection, was discovered. Verapamil was continued and aspirin was initiated, leading to near-complete resolution of previously noted abnormalities at 5 months postpartum.