Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Postpartum cerebral angiopathy -A case report
The vasculopathy associated with co-administration of two vasoconstrictives, methylergometrine maleate and sumatriptan

Shoichiro Sato, M.D., Masaru Shimizu, M.D., Kazuhiro Endo, M.D., Mari Homma, M.D. and Teiji Yamamoto, M.D.

Department of Neurology, Fukushima Medical University School of Medicine

A 25-year-old woman (gravida 1, para 0) who had no history indicating the toxemia of pregnancy developed hypertension and severe throbbing headache after the delivery of her first child by the cesarean section. Generalized tonic-clonic seizure ensued 5 days after the delivery, after which she did not fully regain her consciousness. Her head T2-weighted and FLAIR MRIs showed areas of multiple high intensities in the basal ganglia and cerebral white matter. Her cerebral MRA revealed the segmental stenosis and irregular wall of the major vessels, in particular of the right MCA trunk. Three weeks later, these abnormalities in the neuroimages disappeared and she was free of any symptoms. The history disclosed that obstetricians had used methylergometrine maleate for uterine contraction after delivery and then sumatriptan for her throbbing headache. We speculate that these vasoconstrictive agents might have induced the postpartum cerebral angiopathy. Postpartum cerebral angiopathy may be distinct from reversible posterior leukoencephalopathy in that the abnormalities are not restricted to the posterior lobes and that the vascular changes are apparent on neuroimagings. However, this entity might have a common underlying physiology, which is the abnormally elevated blood pressure that occurs in the setting of early postpartum period. Caution should be exercised when vasoconstrictives are to be used in postpartum period.

(CLINICA NEUROL, 44: 96－101, 2004)
key words: postpartum cerebral angiopathy, eclampsia, reversible posterior leukoencephalopathy, methylergometrine maleate, sumatriptan

(Received: 30-Jul-03)