Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare postpartum
angiopathic syndrome which can cause ischemic or hemorrhagic stroke.
Peripartum cardiomyopathy (PPCM) is a non-ischemiccardiomyopathy that
also occurs postpartum. Here we report a case with concurrent of RCVS
and PPCM. 32 years old female presented with worsening headache since
her vaginal delivery six days ago. For a sudden onset left hemiplegia CT head
showed a large right basal ganglia intracerebral hemorrhage causing midline
shift leading to craniotomy.Cerebral angiogram done the next day showed
diffuse intracranial vasoconstriction suggestive of RCVS and this persisted
on angiogram a week later. Initial echocardiogram was normal with an ejection
fraction (EF) of 6065% that reduced to 15–20% a week later. Postpartum
day 10 she had fixed, dilated pupils. CT brain showed tonsillar herniation
with apnea test confirming brain death. This case is the first one to show
the unique combination of two conditions, PPCM and RCVSand sheds more
light into perhaps common pathophysiologic mechanisms.
Postpartum Cerebral Angiopathy, Reversible Cerebral Vasoconstriction Syndrome, Peripartum cardiomyopathy, Subarachnoid hemorrhage.