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Postpartum RCVS and PRES with normal initial imaging findings


Postpartum angiopathy as clinical presentation of reversible cerebral vasoconstriction syndrome remains an intriguing phenomenon. The diagnosis needs to be considered in women presenting with thunderclap headache with or without associated neurological deficits. Here, we present a patient with thunderclap headache with initial normal laboratory and cerebral imaging findings, including intracranial angiography. Her condition worsened over several days and magnetic resonance imaging revealed changes initially compatible with posterior reversible encephalopathy syndrome, sequentially ischemic stroke and narrowing of the intracranial arteries. Although the patient was in coma for several days, she completely recovered and the focal vasoconstriction fully resolved. This case underscores the complex and variable presentation of postpartum angiopathy and illustrates the diagnosis to be (re)considered even if cerebral vasoconstriction is not documented at the onset of symptoms.

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Robin Lemmens is supported by Research Fund KU Leuven. Vincent Thijs is a Senior Clinical Investigator of FWO Flanders.

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Correspondence to Robin Lemmens.

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Lemmens, R., Smet, S., Wilms, G. et al. Postpartum RCVS and PRES with normal initial imaging findings. Acta Neurol Belg 112, 189–192 (2012).

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  • Reversible cerebral vasoconstriction syndrome
  • Ischemic stroke
  • Posterior reversible leukoencephalopathy syndrome
  • Postpartum angiopathy