Intracerebral hemorrhage and postpartum cerebral vasculopathy

Geocadin, Romergryko G; Razumovsky, Alexander Y; Wityk, Robert J; Bhardwaj, Anish; Ulatowski, John A

« Previous Next »Journal of the Neurological Sciences
Volume 205, Issue 1 , Pages 29-34, 15 December 2002

Intracerebral hemorrhage and postpartum cerebral vasculopathy

Romergryko G Geocadin
- Corresponding author. Neurosciences Critical Care Division, Johns Hopkins Hospital, Meyer 8-140, 600 N. Wolfe Street, Baltimore, MD 21287, USA. Tel.: +1-410-955-7481; fax: +1-410-614-7903
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
Alexander Y Razumovsky
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
Robert J Wityk
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
Anish Bhardwaj
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
John A Ulatowski
- Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA

Received 1 March 2002; received in revised form 18 July 2002; accepted 18 July 2002.

Abstract

Introduction: Intracerebral hemorrhage (ICH) associated with pregnancy commonly occurs in the postpartum period in the setting of preeclampsia/eclampsia. We describe the clinical course of two patients with ICH due to postpartum cerebral vasculopathy in the absence of toxemia. Methods: We reviewed two cases with ICH and postpartum vasculopathy in our hospital (1996–2001) and compared them with seven similar case reports from the literature. Results: Mean age of all patients is 28.7±5.6 years (mean±S.D.). Toxemia of pregnancy was absent in all cases. ICHs were cortical in eight and putaminal in one patient. Erythrocyte sedimentation rate was elevated in two. Two cases rehemorrhaged during the same admission. No cerebral infarctions were reported. All patients had diffuse vasculopathy on conventional catheter angiography, with no clinical manifestations or laboratory data supportive of extracerebral or systemic vasculitis. Eight patients were treated with corticosteroids, two with additional cytotoxic agents and one with nimodipine alone. Improvement on follow-up cerebral angiography (catheter or MRA) and transcranial Doppler ultrasonography (TCD) was noted in eight cases. One did not have follow-up cerebral imaging but had an excellent clinical outcome. All cases had good to excellent functional recovery. Conclusions: Postpartum ICH in the absence of toxemia may be associated with isolated cerebral vasculopathy. The clinical course and functional outcome is good to excellent. This entity appears to be distinct from cerebral vasculitis, which is usually associated with poor outcome.

Keywords: Intracerebral hemorrhage, Postpartum, Vasculitis, Transcranial Doppler ultrasound