Postpartum Four-Vessel Cervical Artery Dissection
A 39-year-old woman had been followed by her obstetrician during her first pregnancy without any complication until the 34th week of gestation when she complained of unusual headaches and epigastric pain. Her blood pressure was found to be 190/110 mm Hg with positive proteinuria findings consistent with a preeclampsia syndrome. Blood samples showed thrombopenia (80,000/mm3) and mild elevation of liver function tests (serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase were 100 IU/mm3). These abnormalities were suggestive of the HELLP syndrome. An emergency caesarean section was performed. The infant's initial Apgar score was 2 and the newborn baby was immediately transferred to the Paediatric Reanimation Department with good achievement a few days later.\nThe mother's blood pressure was controlled with intravenous polytherapy (nicardipine and labetalol). She was transferred to the Reanimation Department due to thrombopenia; at the same time, acute renal failure was observed. On day 10, she presented with spontaneous abnormal movements of her right body side. No focal signs were detected. Brain imaging using fluid-attenuated inversion recovery magnetic resonance (FLAIR-MR) sequences revealed multiple bilateral high signal intensity in the frontoparietal lobes. T1-weighted, fat-suppressed axial cranial MR images (fig. ) showed the presence of a four-vessel CAD with no stroke seen on the diffusion-weighted images. Anticoagulation therapy was started and after a few days, while biological abnormalities improved progressively, the patient was transferred from the Reanimation to the Neurology Department.\nSeveral controls of the cervical arteries using the cervical echo Doppler and transcranial ultrasound system did not show artery modifications, but a second brain MRI revealed the complete withdrawal of the initial FLAIR lesions compatible with the reversible posterior leucoencephalopathy syndrome. The patient was discharged from the hospital at postpartum day 26. An MRA was performed at month 3 coupled with a cervical Doppler examination. Dissection signs had completely resolved at that time. The patient was asymptomatic and the baby was developing normally. After 1 year of follow-up, the patient did not complain of any neurologic symptom.