Fatal puerperal cerebral vasospasm and stroke in a young woman

Although stroke is by no means common in pregnancy, the risk of stroke for a woman rises about 13-fold when she is pregnant. The majority of strokes occurring during pregnancy involve blockage of an artery in the brain. There have been several cases of spasms of cerebral blood vessels associated with pregnancy, but in all these cases, the patient had clear signs of preeclampsia. (This is a complication of pregnancy involving, among other things, a pathological elevation of blood pressure.) A case has now been seen in which a fatal vasospasm developed in a 27-year-old woman in the period after giving birth. The patient developed a headache after going home on the fourth hospital day. Thirteen days after giving birth, the patient developed a transient weakness which affected the left side of her body. The weakness recurred twice the following day. After the patient sought medical attention, imaging of the brain revealed only normal anatomical findings, but a Doppler study demonstrated the presence of turbulent blood flow. Blood normally flows smoothly, and this turbulence indicated the likelihood of a blood vessel spasm. This was confirmed by an angiogram, in which X-rays are used to examine the blood vessels after the patient is injected with a substance to make the blood vessels dark. The patient became unable to speak and confused. When her condition failed to improve, she was transferred to a university hospital, but she arrived there comatose with fixed and dilated pupils. The following day life support was withdrawn. This case is remarkable in that there were no indications of eclampsia or preeclampsia, also called toxemia of pregnancy, in this patient. The case suggests that fatal vasospasm may occur in the puerperal period even without these other complications of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)