Skip to main content
SpringerLink
Log in

Postpartum angiopathy and other cerebral vasoconstriction syndromes

  • Opinions And Arguments
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

The phenomenon of reversible cerebral arterial segmental vasoconstriction has been associated with several conditions, including pregnancy and puerperium (“postpartum angiopathy”), thunderclap headache, and use of vasoconstrictive medications. Patients with cerebral vasoconstriction typically present with sudden, severe, and recurrent (“thunderclap”) headaches and can develop strokes. Cerebral vasoconstriction syndromes are under-recognized, are poorly characterized, and are frequently misdiagnosed as primary cerebral vasculitis. This article presents an illustrative case report and reviews the historical aspects, clinical and imaging characteristics, etiology, differential diagnosis, management, and prognosis of cerebral vasoconstriction syndromes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Serdaru M, Chiras J, Cujas M, Lhermitte F. Isolated benign cerebral vasculitis or migrainous vasospasm? J Neurol Neurosurg Psychiatry 1984;47:73–76.

    PubMed  CAS  Google Scholar 

  2. Schluter A, Kissig B. MR angiography in migrainous vasospasm. Neurology 2002;59:1772.

    PubMed  CAS  Google Scholar 

  3. Jackson M, Lennox G, Jaspan T, Jefferson D. Migraine angiitis precipitated by sex headache and leading to watershed infarction. Cephalalgia 1993;13:427–430.

    Article  PubMed  CAS  Google Scholar 

  4. Rascol A GB, Manelfe C, Clanet M. Accidents vasculaires cerebraux de la grossesse et du post partum. In: II Conference de la Salpetriere sue les maladies vasculaires cerebrales. Hospital de la Salpetriere. Paris: JB Balliere, 1979;84–127.

    Google Scholar 

  5. Bogousslavsky J, Despland PA, Regli F, Dubuis PY. Postpartum cerebral angiopathy: reversible vasoconstriction assessed by transcranial Doppler ultrasounds. Eur Neurol 1989;29:102–105.

    PubMed  CAS  Google Scholar 

  6. Barinagarrementeria F, Cantu C, Balderrama J. Postpartum cerebral angiopathy with cerebral infarction due to ergonovine use. Stroke 1992;23:1364–1366.

    PubMed  CAS  Google Scholar 

  7. Raroque HG, Jr., Tesfa G, Purdy P. Postpartum cerebral angiopathy. Is there a role for sympathomimetic drugs? Stroke 1993;24:2108–2110.

    PubMed  Google Scholar 

  8. Roh JK, Park KS. Postpartum cerebral angiopathy with intracerebral hemorrhage in a patient receiving lisuride. Neurology 1998;50:1152–1154.

    PubMed  CAS  Google Scholar 

  9. Ursell MR, Marras CL, Farb R, Rowed DW, Black SE, Perry JR. Recurrent intracranial hemorrhage due to postpartum cerebral angiopathy: implications for management. Stroke 1998;29:1995–1998.

    PubMed  CAS  Google Scholar 

  10. Zunker P, Golombeck K, Brossmann J, Georgiadis D, Deuschl G. Post-partum cerebral angiopathy: repetitive TCD, MRI, MRA, and EEG examinations. Neurol Res 2002;24:570–572.

    Article  PubMed  Google Scholar 

  11. Bostwick DG. Amphetamine induced cerebral vasculitis. Hum Pathol 1981;12:1031–1033.

    PubMed  CAS  Google Scholar 

  12. Fallis RJ, Fisher M. Cerebral vasculitis and hemorrhage associated with phenylpropanolamine. Neurology 1985;35:405–407.

    PubMed  CAS  Google Scholar 

  13. Forman HP, Levin S, Stewart B, Patel M, Feinstein S. Cerebral vasculitis and hemorrhage in an adolescent taking diet pills containing phenylpropanolamine: case report and review of literature. Pediatrics 1989;83:737–741.

    PubMed  CAS  Google Scholar 

  14. Kaye BR, Fainstat M. Cerebral vasculitis associated with cocaine abuse. JAMA 1987;258:2104–2106.

    Article  PubMed  CAS  Google Scholar 

  15. Ryu SJ, Lin SK. Cerebral arteritis associated with oral use of phenylpropanolamine: report of a case. J Formos Med Assoc 1995;94:53–55.

    PubMed  CAS  Google Scholar 

  16. Bettoni L, Juvarra G, Bortone E, Lechi A. Isolated benign cerebral vasculitis. Case report and review. Acta Neurol Belg 1984;84:161–173.

    PubMed  CAS  Google Scholar 

  17. Snyder BD, McClelland RR. Isolated benign cerebral vasculitis. Arch Neurol 1978;35:612–614.

    PubMed  CAS  Google Scholar 

  18. van Calenbergh F, van den Bergh V, Wilms G. Benign isolated arteritis of the central nervous system. Clin Neurol Neurosurg 1986;88:267–273.

    Article  PubMed  Google Scholar 

  19. Calabrese LH, Gragg LA, Furlan AJ. Benign angiopathy: a distinct subset of angiographically defined primary angiitis of the central nervous system. J Rheumatol 1993;20:2046–2050.

    PubMed  CAS  Google Scholar 

  20. Call GK, Fleming MC, Sealfon S, Levine H, Kistler JP, Fisher CM. Reversible cerebral segmental vasoconstriction. Stroke 1988;19:1159–1170.

    PubMed  CAS  Google Scholar 

  21. Singhal AB. Postpartum angiopathy with reversible posterior leukoencephalopathy. Arch Neurol 2004;61:411–416.

    Article  PubMed  Google Scholar 

  22. Singhal AB, Caviness VS, Begleiter AF, Mark EJ, Rordorf G, Koroshetz WJ. Cerebral vasoconstriction and stroke after use of serotonergic drugs. Neurology 2002;58:130–133.

    PubMed  CAS  Google Scholar 

  23. Apollon KM, Robinson JN, Schwartz RB, Norwitz ER. Cortical blindness in severe preeclampsia: computed tomography, magnetic resonance imaging, and single-photon-emission computed tomography findings. Obstet Gynecol 2000;95:1017–1019.

    Article  PubMed  CAS  Google Scholar 

  24. Steg RE, Kessinger A, Wszolek ZK. Cortical blindness and seizures in a patient receiving FK506 after bone marrow transplantation. Bone Marrow Transplant 1999;23:959–962.

    Article  PubMed  CAS  Google Scholar 

  25. Buckle RM DBG, Smith B. Death due to cerebral vasospasm. J Neurol Neurosurg Psychiatry 1964;27:440–444.

    Article  PubMed  CAS  Google Scholar 

  26. Geraghty JJ, Hoch DB, Robert ME, Vinters HV. Fatal puerperal cerebral vasospasm and stroke in a young woman. Neurology 1991;41:1145–1147.

    PubMed  CAS  Google Scholar 

  27. Singhal AB. Thunderclap headache, reversible cerebral arterial vasoconstriction, and unruptured aneurysms. J Neurol Neurosurg Psychiatry 2002;73:96; author reply 96,97.

    Article  PubMed  CAS  Google Scholar 

  28. Ihara M, Yanagihara C, Nishimura Y. Serial transcranial colorcoded sonography in postpartum cerebral angiopathy. J Neuroimaging 2000;10:230–233.

    PubMed  CAS  Google Scholar 

  29. Gomez CR, Gomez SM, Puricelli MS, Malik MM. Transcranial Doppler in reversible migrainous vasospasm causing cerebellar infarction: report of a case. Angiology 1991;42:152–156.

    PubMed  CAS  Google Scholar 

  30. Konstantinopoulos PA, Mousa S, Khairallah R, Mtanos G. Postpartum cerebral angiopathy: an important diagnostic consideration in the postpartum period. Am J Obstet Gynecol 2004;191:375–377.

    Article  PubMed  Google Scholar 

  31. Jackson A, Stewart G, Wood A, Gillespie JE. Transient global amnesia and cortical blindness after vertebral angiography: further evidence for the role of arterial spasm. AJNR 1995; 16:955–959.

    PubMed  CAS  Google Scholar 

  32. Nighoghossian N, Derex L, Trouillas P. Multiple intracerebral hemorrhages and vasospasm following antimigrainous drug abuse. Headache 1998;38:478–480.

    Article  PubMed  CAS  Google Scholar 

  33. Henderson RD, Rajah T, Nicol AJ, Read SJ. Posterior leukoencephalopathy following intrathecal chemotherapy with MRA-documented vasospasm. Neurology 2003;60:326–328.

    PubMed  CAS  Google Scholar 

  34. Hajj-Ali RA, Furlan A, Abou-Chebel A, Calabrese LH. Benign angiopathy of the central nervous system: cohort of 16 patients with clinical course and long-term followup. Arthritis Rheum 2002;47:662–669.

    Article  PubMed  Google Scholar 

  35. Geocadin RG, Razumovsky AY, Wityk RJ, Bhardwaj A, Ulatowski JA. Intracerebral hemorrhage and postpartum cerebral vasculopathy. J Neurol Sci 2002;205:29–34.

    Article  PubMed  Google Scholar 

  36. Boughammoura A, Touze E, Oppenheim C, Trystram D, Mas JL. Reversible angiopathy and encephalopathy after blood transfusion. J Neurol 2003;250:116–118.

    Article  PubMed  Google Scholar 

  37. Shah AK. Non-aneurysmal primary subarachnoid hemorrhage in pregnancy-induced hypertension and eclampsia. Neurology 2003;61:117–120.

    PubMed  CAS  Google Scholar 

  38. Dodick DW. Thunderclap headache. J Neurol Neurosurg Psychiatry 2002;72:6–11.

    Article  PubMed  CAS  Google Scholar 

  39. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24(Suppl 1):9–160.

    Google Scholar 

  40. Silbert PL, Hankey GJ, Prentice DA, Apsimon HT. Angiographically demonstrated arterial spasm in a case of benign sexual headache and benign exertional headache. Aust N Z J Med 1989;19:466–468.

    PubMed  CAS  Google Scholar 

  41. Nowak DA, Rodiek SO, Henneken S, et al. Reversible segmental cerebral vasoconstriction (Call-Fleming syndrome): are calcium channel inhibitors a potential treatment option? Cephalagia 2003;23:218–222.

    Article  CAS  Google Scholar 

  42. Lee TT, Ragheb J, Bruce JC, Altman N, Morrison G. Diffuse cerebral vasospasm with ischemia after resection of a cerebellopontine angle primitive neuroectodermal tumor in a child. Pediatr Neurosurg 1998;29:300–303.

    Article  PubMed  CAS  Google Scholar 

  43. Akins PT, Levy KJ, Cross AH, Goldberg MP, Schieber MH. Postpartum cerebral vasospasm treated with hypervolemic therapy. Am J Obstet Gynecol 1996;175:1386–1388.

    Article  PubMed  CAS  Google Scholar 

  44. Ringer AJ, Qureshi AI, Kim SH, Fessler RD, Guterman LR, Hopkins LN. Angioplasty for cerebral vasospasm from eclampsia. Surg Neurol 2001;56:373–378; discussion 378,379.

    Article  PubMed  CAS  Google Scholar 

  45. Badjatia N, Topcuoglu MA, Pryor JC, et al. Preliminary experience with intra-arterial nicardipine as a treatment for cerebral vasospasm. AJNR 2004;25:819–826.

    PubMed  Google Scholar 

  46. Meschia JF, Malkoff MD, Biller J. Reversible segmental cerebral arterial vasospasm and cerebral infarction: possible association with excessive use of sumatriptan and Midrin. Arch Neurol 1998;55:712–714.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stroke Service, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA

    Aneesh B. Singhal

  2. Ken and Ruth Davee Department of Neurology and Clinical Neurological Science, Feinberg School of Medicine, NOrthwestern University, Chicago, IL

    Richard A. Bernstein

Authors
  1. Aneesh B. Singhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard A. Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aneesh B. Singhal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singhal, A.B., Bernstein, R.A. Postpartum angiopathy and other cerebral vasoconstriction syndromes. Neurocrit Care 3, 91–97 (2005). https://doi.org/10.1385/NCC:3:1:091

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1385/NCC:3:1:091

Key Words

Search

Navigation