Post-partum cerebral angiopathy. A rare cerebrovascular complication

We describe two patients with post-partum cerebral angiopathy. (Case 1) A 24-year-old patient developed vaginal bleeding 1 day post-partum She received blood transfusion and ergometrine. Four days later she experienced severe occipital headache, loss of vision and generalized seizures. An MRI showed right occipital lesion. She was treated with phenytoin and prednisone. Her vision returned to normal within 2 days. Cerebral angiography showed multiple segmental narrowing; 6h later severe occipital headache and cortical blindness recurred. She was treated with nimodipine and prednisone with complete recovery in 10 days. (Case 2) On the 7th post-partum day a 24-year-old patient was given ergometrine. One day later she developed severe headache and hypertension, followed by drowsiness, right hemiplegia and aphasia. A left frontal hematoma was seen on the CT scan. Cerebral angiography showed multiple segmental narrowing. Resolution of this angiography was confirmed on follow-up angiography. Post-partum cerebral angiopathy is a rare complication of a normal pregnancy. It may present as an ischemic or hemorrhagic stroke. The transience of this severe complication and its association with the administration of drugs,vith strong vasoconstrictive properties suggest an etiological relationship. Other factors and the exact mechanism are unclear. Eur J Neurol 5:411-416 (C) 1998 Lippincott-Raven Publishers.