Abstract Details

Title Bilateral Carotid and Vertebral Artery Dissection Following Cesarean Section

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) (-)

Poster/Presentation
Number 007

Objective

Background Spontaneous multiple precerebral arterial dissection is extremely rare, especially in association with pregnancy. Previous reports of precerebral arterial dissection in the post-partum period were attributed to eclampsia and mechanical straining during vaginal delivery. We report a case of spontaneous dissection of the bilateral carotid and vertebral arteries occurred in a young woman following cesarean section in the absence of mechanical straining, trauma or hypertension.

Design/Methods Case report and review of the literature.

Results A 29-year-old woman presented to the emergency department 2 weeks following an elective cesarean section with a sudden occipital headache, right-side numbness and weakness. Neurological examination revealed right Horner syndrome, mild right hemiparesis and hemianesthesia. Brain MRI revealed a small infarct in the right lower lateral medulla. Cerebral angiography revealed bilateral carotid pseudoaneurysm and vertebral arterial dissections without evidence of fibromuscular dysplasia or atherosclerosis. She was treated with antithrombotic (aspirin 325 mg daily). Cerebral angiography 3 months later showed significant improvement in blood flow in the carotid and vertebrobasilar systems with evidence of resolving pseudoaneurysms in the internal carotid arteries. Follow up after 6 months revealed complete resolution of the neurological symptoms. Similar to our patient, 7 reported cases of post-partum precerbral arterial dissections were associated with vaginal deliveries that had been attributed to the mechanical strain during child birth or eclampsia. One patient had intracranial angiopathy resemble a reversible vasoconstriction syndrome. Four patients treated with anticoagulation. Including our patient, outcome was favorable in all reported cases.

Conclusions Idiopathic multiple precerebral arterial dissection occurred in the post-partum period in the absence of eclampsia, mechanical strain, or vasoconstriction syndrome. Clinical and radiological outcomes are favorable in all reported cases.

Authors/Disclosures
Hesham A. Allam, MD (Saint Louis University Hospital) PRESENTER	Dr. Allam has nothing to disclose.
Aws Alawi, MD (Swedish Neuroscience Institute)	No disclosure on file
Amer Alshekhlee, MD (SSM Health)	No disclosure on file
Nirav Vora, MD	No disclosure on file
Sonal Mehta, MD (Tenet Advanced Neuroscience Network)	Dr. Mehta has nothing to disclose.
Pablo Villoslada, MD, PhD, FAAN (Hospital del Mar Research Institute)	Dr. Villoslada has received personal compensation for serving as an employee of Attune Neuroscience. Dr. Villoslada has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Accure Therapeutics. Dr. Villoslada has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Oculis. Dr. Villoslada has stock in Attune Neurosciences. Dr. Villoslada has stock in Bionure Investments. Dr. Villoslada has stock in Spiral Therapeutics. Dr. Villoslada has stock in Adhera Health. The institution of Dr. Villoslada has received research support from Start2Cure Foundation. The institution of Dr. Villoslada has received research support from NIH. The institution of Dr. Villoslada has received research support from Department of Defense. Dr. Villoslada has received intellectual property interests from a discovery or technology relating to health care.

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