Variable presentations of postpartum angiopathy

Jennifer E. Fugate, Sebastián F. Ameriso, Gustavo Ortiz, Lucia V. Schottlaender, Eelco F M Wijdicks, Kelly D. Flemming, Alejandro A. Rabinstein

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE-: Postpartum angiopathy (PPA), a rare cause of stroke in the puerperium, is heralded by severe headaches within 1-2 weeks after delivery. Angiography demonstrates segmental vasoconstriction that often resolves spontaneously. PPA is generally regarded as benign. We aimed to define clinical presentations, radiological findings, and outcomes of patients with PPA. METHODS-: We retrospectively reviewed patients from 3 centers with acute neurological symptoms and angiography showing vasoconstriction in the postpartum period. Patients without neuroimaging and with diagnoses of cerebral venous sinus thrombosis and aneurysmal hemorrhage were excluded. Patient characteristics, clinical symptoms, neuroimaging findings, and clinical condition at hospital discharge were collected. RESULTS-: Eighteen patients (mean age, 31 years; range, 15-41) were identified. Median gestation was 38 weeks. Twelve (67%) had a history of prior uneventful pregnancy. Neurological symptoms began on median day 5 postpartum and included headache (n=16, 89%), focal deficit (n=9, 50%), visual disturbance (n=8, 44%), encephalopathy (n=6, 33%), and seizure (n=5, 28%), often in combination. Brain imaging was abnormal in most (n=13, 72%). The most common abnormalities were intracranial hemorrhage (n=7, 39%), vasogenic edema (n=6, 35%), and infarction (n=6, 35%). Clinical outcomes were markedly variable with full recovery seen in 9 (50%), death after a fulminant course in 4 (22%), and residual deficits in 5 (28%). CONCLUSIONS-: In contrast to prior reports, this group of patients with PPA had a higher proportion of nonbenign outcomes. Most patients who undergo neuroimaging have parenchymal abnormalities, which are most often stroke (hemorrhagic or ischemic) or reversible vasogenic edema.

Original languageEnglish
Pages (from-to)670-676
Number of pages7
JournalStroke
Volume43
Issue number3
DOIs
StatePublished - Mar 1 2012

Fingerprint

Postpartum Period
Neuroimaging
Vasoconstriction
Headache
Edema
Angiography
Stroke
Intracranial Sinus Thrombosis
Pregnancy
Intracranial Hemorrhages
Brain Diseases
Venous Thrombosis
Infarction
Seizures
Hemorrhage

Keywords

  • acute stroke
  • eclampsia
  • intracranial hemorrhage
  • postpartum angiopathy
  • PRES
  • reversible cerebral vasoconstriction syndrome
  • women

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Fugate, J. E., Ameriso, S. F., Ortiz, G., Schottlaender, L. V., Wijdicks, E. F. M., Flemming, K. D., & Rabinstein, A. A. (2012). Variable presentations of postpartum angiopathy. Stroke, 43(3), 670-676. https://doi.org/10.1161/STROKEAHA.111.639575

Variable presentations of postpartum angiopathy. / Fugate, Jennifer E.; Ameriso, Sebastián F.; Ortiz, Gustavo; Schottlaender, Lucia V.; Wijdicks, Eelco F M; Flemming, Kelly D.; Rabinstein, Alejandro A.

In: Stroke, Vol. 43, No. 3, 01.03.2012, p. 670-676.

Research output: Contribution to journalArticle

Fugate, JE, Ameriso, SF, Ortiz, G, Schottlaender, LV, Wijdicks, EFM, Flemming, KD & Rabinstein, AA 2012, 'Variable presentations of postpartum angiopathy', Stroke, vol. 43, no. 3, pp. 670-676. https://doi.org/10.1161/STROKEAHA.111.639575
Fugate JE, Ameriso SF, Ortiz G, Schottlaender LV, Wijdicks EFM, Flemming KD et al. Variable presentations of postpartum angiopathy. Stroke. 2012 Mar 1;43(3):670-676. https://doi.org/10.1161/STROKEAHA.111.639575
Fugate, Jennifer E. ; Ameriso, Sebastián F. ; Ortiz, Gustavo ; Schottlaender, Lucia V. ; Wijdicks, Eelco F M ; Flemming, Kelly D. ; Rabinstein, Alejandro A. / Variable presentations of postpartum angiopathy. In: Stroke. 2012 ; Vol. 43, No. 3. pp. 670-676.
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abstract = "BACKGROUND AND PURPOSE-: Postpartum angiopathy (PPA), a rare cause of stroke in the puerperium, is heralded by severe headaches within 1-2 weeks after delivery. Angiography demonstrates segmental vasoconstriction that often resolves spontaneously. PPA is generally regarded as benign. We aimed to define clinical presentations, radiological findings, and outcomes of patients with PPA. METHODS-: We retrospectively reviewed patients from 3 centers with acute neurological symptoms and angiography showing vasoconstriction in the postpartum period. Patients without neuroimaging and with diagnoses of cerebral venous sinus thrombosis and aneurysmal hemorrhage were excluded. Patient characteristics, clinical symptoms, neuroimaging findings, and clinical condition at hospital discharge were collected. RESULTS-: Eighteen patients (mean age, 31 years; range, 15-41) were identified. Median gestation was 38 weeks. Twelve (67{\%}) had a history of prior uneventful pregnancy. Neurological symptoms began on median day 5 postpartum and included headache (n=16, 89{\%}), focal deficit (n=9, 50{\%}), visual disturbance (n=8, 44{\%}), encephalopathy (n=6, 33{\%}), and seizure (n=5, 28{\%}), often in combination. Brain imaging was abnormal in most (n=13, 72{\%}). The most common abnormalities were intracranial hemorrhage (n=7, 39{\%}), vasogenic edema (n=6, 35{\%}), and infarction (n=6, 35{\%}). Clinical outcomes were markedly variable with full recovery seen in 9 (50{\%}), death after a fulminant course in 4 (22{\%}), and residual deficits in 5 (28{\%}). CONCLUSIONS-: In contrast to prior reports, this group of patients with PPA had a higher proportion of nonbenign outcomes. Most patients who undergo neuroimaging have parenchymal abnormalities, which are most often stroke (hemorrhagic or ischemic) or reversible vasogenic edema.",
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