Abstract Details

Title Blood Patch May Precipitate Ischemic Stroke in the Setting of Postpartum Angiopathy and Reversible Posterior Leukoencephalopathy Syndrome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 057

Objective

Background BACKGROUND: Stroke in the peripartum period contributes to severe maternal morbidity and mortality. Post-lumbar puncture headache may occur after epidural analgesia during labor. Treatment of post-lumbar puncture headache with blood patch is typically safe.

Design/Methods DESIGN/METHODS: We report an unusual case of ischemic stroke complicating the postpartum period and blood patch.

Results RESULTS: A 37 year old female received spinal epidural analgesia during an uncomplicated vaginal delivery. Five days postpartum, she experienced headache, nuchal rigidity, and seizure. Magnetic resonance imaging (MRI) revealed hyperintensities on fluid attenuated inversion recovery (FLAIR) sequence consistent with reversible posterior leukoencephalopathy syndrome (RPLS). Days later, she experienced worsening headache and transient right arm numbness. Multiple focal areas of intracranial stenosis on magnetic resonance angiogram (MRA) were consistent with postpartum angiopathy (PPA). Two weeks postpartum, she continued with worsening headache and she received a 20cc autologous EBP for presumed post-lumbar puncture headache. Immediately following EBP administration, she developed a right homonymous hemianopsia. Magnetic resonance imaging revealed restricted diffusion in the territory of the left posterior cerebral artery. In addition, repeat MRA revealed worsening of the narrowed cerebrovasculature compared to MRA prior to EBP.

Conclusions CONCLUSIONS: Prior studies have demonstrated a relationship between peripartum vasculopathy and stroke. Other literature suggests a relationship between EBP and ischemic infarct. Epidural blood patch administration may alter cerebral blood flow, although the mechanism is not well defined. For patients with predisposing risk factors for stroke, the vasomotor effects of EBP may decrease a threshold for ischemic event to occur. Perhaps, in women with PPA or RPLS who develop post-lumbar puncture headache, EBP should be avoided as a therapeutic approach.

Authors/Disclosures
Amanda Jagolino-Cole, MD, FAAN (University of Texas Health Science Center At Houston) PRESENTER	Dr. Jagolino-Cole has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ��ɫ�� - Neurology Clinical Practice Journal. .
	No disclosure on file
Manuel S. Nunez Castillo, MD (Hospital Victor Larco Herrera)	No disclosure on file
	No disclosure on file
Edward Fox, MD, PhD, FAAN	Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GW Pharmaceuticals. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. The institution of Dr. Fox has received research support from Biogen. The institution of Dr. Fox has received research support from Genentech. The institution of Dr. Fox has received research support from Celgene - BMS. The institution of Dr. Fox has received research support from Chugai. The institution of Dr. Fox has received research support from Novartis. The institution of Dr. Fox has received research support from EMD-Serono. The institution of Dr. Fox has received research support from TG Therapeutics. The institution of Dr. Fox has received research support from AbbVie. The institution of Dr. Fox has received research support from Sanofi Genzyme. The institution of Dr. Fox has received research support from AbbVie.
Gustavo Ortiz, MD (University of Miami Miller School of Medicine)	No disclosure on file
	No disclosure on file

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