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(Stroke. 1998;29:1995-1998.)
© 1998 American Heart Association, Inc.

Case Report

Recurrent Intracranial Hemorrhage Due to Postpartum Cerebral Angiopathy

Implications for Management

Melanie R. Ursell, MD; Connie L. Marras, MD; Richard Farb, MD; David W. Rowed, MD; Sandra E. Black, MD; James R. Perry, MD

From the Divisions of Neurology (M.R.U., S.E.B., J.R.P.) and Neurosurgery (C.L.M., D.W.R.) and the Department of Radiology (R.F.), Sunnybrook Health Science Centre, Toronto, Canada.

Correspondence to Melanie R. Ursell, MD, Room A-442, Division of Neurology, Sunnybrook Health Science Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5.

Background—Postpartum cerebral angiopathy as a cause of hemorrhagic stroke in young women is not well recognized. It is unknown whether this disorder represents a true inflammatory vasculitis or transient vasoconstriction related to the hormonal events of pregnancy and the postpartum period.

Case Description—A 39-year-old woman presented with postpartum intracranial hemorrhage and, 32 months later, with subarachnoid hemorrhage, following normal pregnancies. Cerebral angiography obtained after each stroke demonstrated diffuse irregularity of branches of the middle cerebral arteries consistent with a diffuse vasospastic process or classic vasculitis. Neurological deficits resolved and results of a transcranial Doppler study normalized after a short course of high-dose corticosteroids following the second stroke.

Conclusions—Postpartum cerebral angiopathy should be considered in the differential diagnosis of recurrent intracranial hemorrhagic stroke in young women. Recognition of this condition may preclude treatment with potentially toxic therapies for vasculitis and will have important implications for counseling women on subsequent pregnancies.

Key Words: cerebral hemorrhage • vasoconstriction • pregnancy • vasculitis

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